Intraoperative Hyperglycemia during Liver Resection: Predictors and Association with the Extent of Hepatocytes Injury

BackgroundPatients undergoing liver resection are at risk for intraoperative hyperglycemia and acute hyperglycemia is known to induce hepatocytes injury. Thus, we aimed to evaluate whether intraoperative hyperglycemia during liver resection is associated with the extent of hepatic injury.MethodsThis 1 year retrospective observation consecutively enrolled 85 patients undergoing liver resection for hepatocellular carcinoma. Blood glucose concentrations were measured at predetermined time points including every start/end of intermittent hepatic inflow occlusion (IHIO) via arterial blood analysis. Postoperative transaminase concentrations were used as surrogate parameters indicating the extent of surgery-related acute hepatocytes injury.ResultsThirty (35.5%) patients developed hyperglycemia (blood glucose > 180 mg/dl) during surgery. Prolonged (≥ 3 rounds) IHIO (odds ratio [OR] 7.34, P = 0.004) was determined as a risk factors for hyperglycemia as well as cirrhosis (OR 4.07, P = 0.022), lower prothrombin time (OR 0.01, P = 0.025), and greater total cholesterol level (OR 1.04, P = 0.003). Hyperglycemia was independently associated with perioperative increase in transaminase concentrations (aspartate transaminase, β 105.1, standard error 41.7, P = 0.014; alanine transaminase, β 81.6, standard error 38.1, P = 0.035). Of note, blood glucose > 160 or 140 mg/dl was not associated with postoperative transaminase concentrations.ConclusionsHyperglycemia during liver resection might be associated with the extent of hepatocytes injury. It would be rational to maintain blood glucose concentration【背景】接受肝切除术（liver resection）的患者存在术中高血糖风险，而急性高血糖已被证实可诱发肝细胞损伤（hepatocytes injury）。本研究旨在评估肝切除术患者的术中高血糖是否与肝损伤程度相关。 【方法】本研究为为期1年的回顾性观察研究，连续纳入85例因肝细胞癌（hepatocellular carcinoma）接受肝切除术的患者。通过动脉血液分析，在预设时间点（包括每次间歇性肝血流阻断（intermittent hepatic inflow occlusion，IHIO）的开始与结束时刻）采集血糖浓度数据。以术后转氨酶浓度作为反映手术相关急性肝细胞损伤程度的替代指标。 【结果】术中共有30例（35.5%）患者出现高血糖（血糖>180mg/dl）。研究确定，延长的间歇性肝血流阻断（≥3次循环，比值比（odds ratio，OR）=7.34，P=0.004）、肝硬化（OR=4.07，P=0.022）、较低的凝血酶原时间（OR=0.01，P=0.025）以及较高的总胆固醇水平（OR=1.04，P=0.003）均为术中高血糖的危险因素。术中高血糖与围手术期转氨酶浓度升高独立相关（天冬氨酸转氨酶（aspartate transaminase）：β=105.1，标准误=41.7，P=0.014；丙氨酸转氨酶（alanine transaminase）：β=81.6，标准误=38.1，P=0.035）。值得注意的是，血糖>160mg/dl或>140mg/dl与术后转氨酶浓度无显著关联。 【结论】肝切除术患者术中的高血糖可能与肝细胞损伤程度相关，维持血糖浓度具有实践合理性。