不同药物洗肠对原发性肝癌患者术后血氨水平的影响

摘要

Objective To study the effect on level of blood ammonia for patients with hepatocellular carcinoma (HCC) by different intestinal preparation.Method 150 patients with HCC were randomly divided into five groups.Patients in group A were treated with oral sodium phosphate (NaP),patients in group B were treated with oral 25 ％ magnesium sulfate,patients in group C were treated with oral Lactulose oral solution.Patients in group D were treated with polyethylene glycol electrolyte bulk while group E was as the control group in which patients were without any bowel preparation before surgery.The recovery time of intestines function was observed.In addition,venous blood was extracted preoperatively and on the first day,third day,fifth day and seventh day after operation,for testing the level of blood ammonia.Result There was no significant difference about the recovery time of intestines function among the five groups.On the first and third day after operation,the lever of blood ammonia among groups is similar; however,the lever of group C was significantly lower than group E.On the fifth and seventh day after operation,the lever of blood ammonia in the first four groups was significantly lower than that of group E,while group C was the lowest.Conclusion Oral lactulose is suitable intestinal preparation drug,with lower blood ammonia after operation for HCC patients.It's worthy of clinical application.%目的 对比不同药物洗肠对肝细胞性肝癌术后血氨水平的影响.方法 以150例肝细胞性肝癌患者作为研究对象,随机分为A、B、C、D、E5组,每组30例,分别采用磷酸钠盐口服溶液(A组),25％硫酸镁口服溶液(B组),乳果糖口服溶液(C组),聚乙二醇电解质散(D组)4种药物作为口服洗肠药物,E组为空白对照组,术前不进行肠道准备,观察各组术后肠功能恢复时间,术前及术后第1天、第3天、第5天、第7天血氨水平.结果 各组患者术后肠功能恢复时间差异无显著意义(P＞0.05).各组术后第1天、第3天血氨水平差异无显著意义(P＞0.05),但C组血氨水平显著低于E组(P＜0.05)；术后第5天、第7天,4个洗肠组血氨水平显著低于空白对照组(P＜0.01),其中C组血氨水平显著低于A、B、D组(P＜0.05).结论 肝细胞性肝癌患者术前是否洗肠或使用何种药物洗肠,对术后肠功能恢复时间无明显影响；乳果糖对改善术后血氨水平促进肝功能早期恢复方面优于硫酸镁、聚乙二醇和磷酸钠盐等洗肠药物,值得临床推广应用.