乳果糖对肝癌切除术后血浆内毒素血症及肝损伤的防护作用

目的：探讨乳果糖对肝脏缺血再灌注后内毒素血症所致肝损伤的防护作用。方法：40例肝癌患者随机分为乳果糖组及对照组。测定两组肝癌手术患者肝门阻断前后门静脉血、外周静脉血内毒素以及术前、术后第1、3、7天肝功能检测结果，做统计学分析。结果：肝门阻断前，乳果糖组患者内毒素水平要低于对照组（t=27．60，P〈0．01）：肝门阻断后，两组患者内毒素水平均升高，但对照组更高，差异有极显著意义（t=12．72，P〈0．01），说明乳果糖可以明显减轻内毒素血症。术前两组患者血中丙氨酸转氨酶（ALT）和天门冬氨酸转氨酶（AST）均高于正常参考值，但乳果糖组较对照组略低，差异有统计学意义（t=4．28，P〈0．01；t’=4．91，P〈0．05），术后第3天两组患者ALT和AST升高的水平最高，两组问差异有统计学意义（t’=2．11，P〈0．05）。结论：肝切除术前患者口服乳果糖，能降低其肝缺血后血中内毒素水平，减轻肝脏的缺血再灌注损伤，改善肝脏功能，有利于术后肝功能的恢复，对于预防术后急性肝功能衰竭起一定作用。

Preventive dffects of lactulose on endotoxemia and liver injury after hepatic carcinectomy

Objective： To investigate the preventive effects of lactulose on liver injury induced by hepatic ischemia reperfu- sion and endotoxemia. Methods： Forty patients with liver cancer were randomly divided into oral lactulose and control group. The levels of endotoxin were detected in the peripheral vein and portal vein before or after blocking of hepatic portal, and liver function was detected in preoperative and 1, 3, 7 days after operation, then the data were analyzed,statistically. Results： The levels of endotoxin in lactulose group was lower than that in control group before blocking of hepatic portal （ t = 27. 60, P 〈 0.01 ） ; The value of endotoxin was risen up in both groups after blocking of hepatic portal, but significantly in control group （ t = 12. 72, P 〈0. 01 ）, it demonstrated that lactulose could relieve endotoxemia. The value of ALT and AST were higher than reference value in both groups, a little bit lower in lactulose group （ t = 4. 28, P 〈 0. 01 ; t＇ = 4. 91, P 〈 0.05 ）, those were remarkably highest on the 3rd day after operation, the variance in both groups was statistical significance （t＇ = 2. 11, P 〈 0. 05 ） . Conclusion： It can lower the levels of endotoxin by oral lactulose before hepatectomy, and relieve the damage of hepatic ischemia reperfusion, and improve the liver function, be good to liver recover, partly prevent acute liver failure after operation.