Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
HPB (Oxford). 2013 Jun;15(6):457-62. doi: 10.1111/hpb.12005. Epub 2013 Jan 7.
Post-operative hepatic dysfunction is a major cause of concern when undertaking a liver resection. The generation of reactive oxygen species (ROS) as a result of hepatic ischaemia/reperfusion (I/R) injury can result in hepatocellular injury. Experimental evidence suggests that N-acetylcysteine may ameliorate ROS-mediated liver injury.
A cohort of 44 patients who had undergone a liver resection and receiving peri-operative N-acetylcysteine (NAC) were compared with a further cohort of 44 patients who did not. Liver function tests were compared on post-operative days 1, 3 and 5. Peri-operative outcome data were retrieved from a prospectively maintained database within our unit.
Administration of NAC was associated with a prolonged prothrombin time on the third post-operative day (18.4 versus 16.4 s; P = 0.002). The incidence of grades B and C liver failure was lower in the NAC group although this difference did not reach statistical significance (6.9% versus 14%; P = 0.287). The overall complication rate was similar between groups (32% versus 25%; P = ns). There were two peri-operative deaths in the NAC group and one in the control group (P = NS).
In spite of promising experimental evidence, this study was not able to demonstrate any advantage in the routine administration of peri-operative NAC in patients undergoing a liver resection.
肝切除术后肝功能障碍是人们关注的主要问题。肝缺血/再灌注（I/R）损伤导致活性氧（ROS）的产生可导致肝细胞损伤。实验证据表明，N-乙酰半胱氨酸（NAC）可能改善 ROS 介导的肝损伤。
将接受围手术期 N-乙酰半胱氨酸（NAC）治疗的 44 例肝切除术患者与未接受 NAC 治疗的 44 例患者进行比较。比较术后第 1、3、5 天的肝功能检查结果。围手术期结果数据从我们单位的一个前瞻性维护数据库中检索。
NAC 给药与术后第 3 天的凝血酶原时间延长有关（18.4 秒比 16.4 秒；P = 0.002）。NAC 组的 B 级和 C 级肝功能衰竭发生率较低，但差异无统计学意义（6.9%比 14%；P = 0.287）。两组的总体并发症发生率相似（32%比 25%；P = NS）。NAC 组有 2 例围手术期死亡，对照组有 1 例（P = NS）。
尽管有有前景的实验证据，但本研究未能证明肝切除术患者常规围手术期应用 NAC 有任何优势。
