经颈内静脉肝内门体静脉分流术后肝性脑病危险因素分析

摘要

Objective To investigate the causes of hepatic encephalopathy (HE) after the transjugular intrahepatic portosystemic shunt (TIPS) and to put forward preventive measures. Methods 50 patients with TIPS admitted to our hospital during June 2006 and August 2012 were divided into HE group (9 cases) and non HE group (41 cases) according to postop-erative HE. 1 d before and 3 d, 7 d after operation and postoperative HE in effect at the time of the blood ammonia, alanine transaminase and total bilirubin levels were compared. The single factor and multiple factor regression analysis, risk factors of postoperative HE TIPS were summarized. Results Compared with that of preoperative 1 d, in HE group 3 d and 7 d after blood ammonia, total bilirubin levels were significantly higher than those in non HE group (P < 0. 05); in HE group, blood ammonia [(91. 2 ± 32. 5) μmol/ L], total bilirubin [(64. 6 ± 45. 7) μmol/ L] levels were significantly higher (P < 0. 05) during HE. Incidence of Child-Pugh C level of patients with HE was higher than B (P < 0. 05), and A level (P < 0. 01), single factor and multiple factors regression analysis showed that preoperative total bilirubin and blood ammonia levels and liver function classification were closely related with HE. Conclusion The increase of preoperative serum total bilirubin and blood ammonia level and high liver function classification may be independent risk factors for the development of HE, therefore the indications of TIPS should be fully understood before TIPS operation in order to reduce incidence rate and prevent HE.%目的：探讨经颈内静脉肝内门体静脉分流术(transjugular intrahepatic portalsystemic shunt, TIPS)后肝性脑病(hepatic encephalopathy, HE)发生的原因及防治措施。方法将我院2006年6月—2012年8月50例 TIPS 患者根据术后是否发生 HE 分为 HE 组(9例)和非 HE 组(41例)。对两组术前1 d、术后3 d、术后7 d 及 HE 发生时的血氨、丙氨酸转氨酶和总胆红素水平进行比较。进一步行单因素及多因素回归分析,总结 TIPS 术后 HE 发生的危险因素。结果与非 HE 组相比,HE 组术前1 d 及术后3 d、7 d 血氨及总胆红素水平均升高(P <0．05)；与术前1 d 相比,两组术后3 d、7 d 血氨及总胆红素水平均显著升高(P <0．05)；HE 组发生 HE 时血氨[(91.2±32.5)μmol/ L]、总胆红素[(64.6±45.7)μmol/ L]水平均显著升高(P <0.05)。 Child-Pugh C 级患者术后 HE 发生率高于 B 级者(P <0．05)和 A 级者(P <0．01)。单因素及多因素回归分析显示,术前肝功能分级、术前血氨和术前总胆红素与 HE 的发生密切相关。结论术前高的肝功能分级以及血氨、血总胆红素水平的升高可能是 HE 发生的独立危险因素,因此 TIPS 术前应严格掌握手术适应证,以减少或避免术后 HE 的发生。