Basic And Clinical Study Of Perioperative Control Of Stress Metabolism Combined With Enteral Nutrition For Postoperative Rehabilitation

Preoperative ulinastatin promotes liver function via AMPK signaling after partial hepatectomy in miceObjective: To investigate the effect of preoperative ulinastatin on liver function and AMPK signal pathway after 70% hepatectomy in mice.Methods: A total of 48 male ICR mice weighing 25-30 g were randomly divided into control group and ulinastatin group. Blood and liver tissue samples were collected at day 1, 3, 5 and 7 after 70% hepatectomy, then serum alanine aminotransferase(ALT), aspartate transaminase(AST), total bilirubin(TB) and lactate dehydrogenase(LDH) levels were measured, while liver tissue were used to morphology study and AMPK signaling analysis.Results: Serum AST levels at day 1 and 3 and serum LDH levels at day 3 after hepatectomy were significantly lower in the ulinastatin group than those in control group(p<0.05). Subsequently mechanism analysis revealed that AMPK signaling was activated significantly later and bile salt export protein(BSEP) was expressed higher in the ulinastatin group than those in control group. There were no significant differences between the ulinastatin group and control group with regard to ALT, TB and morphology.Conclusion: Ulinastatin can reduce liver injury with promoting the recovery of liver function after liver resection, which may be due to the maintained hepatocyte energy supply and promoted hepatocyte polarization.Prospective Study of Positive Effect of Intraoperative Methyprednisolone combined with Perioperative Enteral Nutrition Support on The Recovery after HepatectomyObjective: The aim of this prospective study was to investigate the clinical efficacy of intraoperative methylprednisolone combined with perioperative enteral nutrition(EN) support in the early recovery after hepatectomy.Methods: 79 patients treated with hepatectomy at Drum Tower Hospital between June 2013 and May 2014 were divided into either a control group(n=39) or a steroid group(n=40). The control group underwent hepatectomy only, and the steroid group underwent hepatectomy combined with intraoperative methylprednisolone use. Both of the two groups were given the same perioperative enteral(EN) nutrition support.Clinical results were compared between the two groups.Result: The serum levels of C-reactive protein(CRP) on days 1 and 3 after hepatectomy were significantly lower in the steroid group than in the control group(t=2.933, t=4.127, P<0.05).The serum levels of prealbumin(PA) on day 3 after hepatectomy were significantly higher in the steroid group than in the control group(t=-1.607, P<0.05).The serum levels of cholinesterase on day 1 after hepatectomy were significantly higher in the steroid group than in the control group(t=-3.136,P<0.05).The postoperative hospitalization time was significantly shorter in the steroid group than in the control group(t=1.514, P<0.05).There were no significant differences between the steroid group and control group with regard to alanine aminotransferase(ALT), aspartate transaminase(AST), total bilirubin(TB)and albumin(ALB)(P>0.05). There were no significant differences between the steroid group and control group with regard to the total volume of albumin transfusion, the first anal exhaust time and the incidence of complications after liver resection(P>0.05).Conclusion: These results suggest that intraoperative use of methylprednisolone can inhibit the inflammatory response, promote the early recovery of liver synthetic function with perioperative enteral nutrition support and shorten the length of postoperative hospitalization time.