特利加压素对肝硬化门脉高压患者围术期肾保护作用的探讨

doi:10.3969/j.issn.1006-7795.2018.05.022

摘要/Abstract

摘要： 目的探讨肝硬化门脉高压患者脾切除术中应用特利加压素对围术期肾功能的潜在保护作用。方法 42例静脉注射复合吸入麻醉下择期行脾切除加贲门周围血管离断术的乙/丙肝后肝硬化患者，年龄18~65岁，未行静脉－静脉转流术，ASAⅡ或Ⅲ级，按数字表法随机分为试验组和对照组2组（每组n=21）。试验组手术开始即刻静脉输注特利加压素［2 mg溶于50 mL 0.9%（质量分数）氯化钠注射液］10 mL/h至术毕。对照组以等容量0.9%（质量分数）氯化钠注射液代替。测定术后3 d急性肾损伤（acute kidney injury，AKI）发病率和肾功能指标，包括麻醉前即刻（T1）、术毕（T2）、术后第1天（T3）和术后第3天（T4）的尿N-乙酰-β-D-葡萄糖苷酶（N-acetyl-β-D-glucosidase，NAG）和尿β2微球蛋白（β2-microglobulin，β2-MG）、尿微量白蛋白（microalbuminuria，Malb）、尿α1微球蛋白（α1-microglobulin，α1-MG）、血尿素氮（blood urea nitrogen，BUN）、血肌酐（serum creatinine，SCr）、血β2-MG、血清胱抑素C （serum cystatin C，CysC）、肾小球滤过率（glomerular filtration rate，GFR）、尿量、利尿剂用量等。结果两组患者术后3 d均未发生AKI。各项肾功能指标，除试验组术后利尿剂用量较对照组明显减少（P<0.05）外，两组组间比较均差异无统计学意义。但是组内分别比较时，两组还是存在不同。试验组GFR在术后T4时点比麻醉前（T1）显著升高（P<0.01），而对照组差异无统计学意义；对照组尿β2-MG在术后T2、T3时点比麻醉前（T1）显著升高（P<0.01），但是在试验组内各时间点差异没有统计学意义。结论肝硬化门脉高压脾切除患者术中静脉输注特利加压素可能有潜在的改善术后GFR的作用，但本研究结果尚不能确定其对围术期肾功能的明确保护作用。

关键词: 特利加压素, 脾切除术, 肾功能试验, 肝硬化, 肝肾综合征

Abstract: Objective To explore the effects of terlipressin on perioperative renal protection in patients with liver cirrhosis and portal hypertension splenectomy. Methods Forty-two American Society of Anesthesiologists (ASA) Ⅱor Ⅲ patients(28 male,14 female) aged 18-65 Year weighing 44-85 kg were randomly divided into 2 groups (n=21 each):terlipressin group and control group.In terlipressin group 2 mg of terlipressin was added to 50 mL of normal saline (NS) and was continuously infused at 10 mL/h from beginning of operation until the end of the operation,while in control group NS was infused instead of terlipressin. Three days after the incidence of acute kidney injury(AKI) and renal index. Blood and urine samples were taken before operation(T1 baseline),after operation(T2) and on the first and third day after operation(T3,T4) for determination of urinary N-acetyl-β-D-glucosidase (NAG), β2-microglobulin(β2-MG), microalbuminuria(Malb),α1-microglobulin(α1-MG),blood urea nitrogen(BUN), serum creatinine (SCr), blood β2-MG and serum cystatin C(CysC) concentration, glomerular filtration rate (GFR), urine,diuretic use in the urine.Results Two groups of patients did not occur AKI after the operation. Various renal function indicators has no statistically significant difference in the group except the diuretics were significantly lower at T2 in terlipressin group than in control group(P<0.05).But there were still some differences between the two groups when comparison was respectively made inside the groups.The GFR in the experimental group T4 was significantly increased than that of T1, while the control group have no significantly difference (P<0.01).Postoperative renal function indexes between groups, the urine β2-MG were significantly increased at T2 and T3 as compared with the baseline at T1 in control group(P<0.01),but there was no statistical difference in the experimental group. Conclusion Intravenous infusion of terlipressin may have the potential to improve the postoperative GFR in patients with liver cirrhosis and portal hypertension splenectomy, but the results still can not determine the protective effect of renal function perioperatively.

Key words: terlipressin, splenectomy, kidney function tests, cirrhosis, hepatorenal syndrome

中图分类号:

R657.3⁺1

丁乔, 岳云, 程灏. 特利加压素对肝硬化门脉高压患者围术期肾保护作用的探讨[J]. 首都医科大学学报, 2018, 39(5): 741-746.

Ding Qiao, Yue Yun, Cheng Hao. Effects of terlipressin on perioperative renal protection inpatients with liver cirrhosis and portal hypertension[J]. Journal of Capital Medical University, 2018, 39(5): 741-746.

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