急性肝衰竭肝移植围手术期治疗的研究进展

Clinical effects of application of nursing process in living donor liver transplant operation

AIM: To explore the clinical effects of application of nursing process in living donor liver transplant operation.

METHODS: Seven patients who underwent living donor liver transplantation were cared using the nursing process (experiment group), and 6 patients who underwent living donor liver transplantation did not receive care using the nursing process (control group). The donor liver cold ischemia time, operative time, surgery cost, pH, BE, HCO₃^-, PaCO₂, Na⁺, K⁺, Cl^-, Ca²⁺, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) and surgeon's satisfaction to nursing were compared between the two groups.

RESULTS: The donor liver cold ischemia time and operative time in the experiment group were significantly lower than those in the control group (81.13 min ± 19.65 min vs 106.93 min ± 21.36 min, 11.15 h ± 1.05 h vs 15.96 h ± 3.81 h, P < 0.05). The costs of anesthesia, transportation, and one-time items were significantly lower in the experiment group than in the control group (5026.57 yuan ± 805.12 yuan vs 5669.05 yuan ± 740.17 yuan, 1020.89 yuan ± 132.77 yuan vs 1268.10 yuan ± 150.52 yuan, 5500.22 yuan ± 615.33 yuan vs 6263.31 yuan ± 505.48 yuan, P < 0.05). The surgeon's satisfaction to nursing in the experiment group was significantly higher than that in the control group (100.00% vs 83.33%, P < 0.05). There were no significant differences in blood gas parameters tested (P > 0.05) or hemodynamic indexes in the new liver between the two groups (P > 0.05).

CONCLUSION: Application of the nursing process can improve the effectiveness and standardization of nursing in living donor liver transplant operation in terms of enhancing the nursing cooperation efficiency, saving health resources, reducing the costs of treatment, and improving the clinical effects.

Effect of P38MAPK inhibitor on endoplasmic reticulum stress-induced hepatocyte apoptosis in rats with acute liver failure

AIM: To observe the effect of P38MAPK inhibitor SB203580 on Caspase12 protein expression and apoptosis of hepatocytes in rats with acute hepatic failure, and to explore the mechanism underlying its protective effect on acute hepatic failure.

METHODS: Seventy-two healthy Wistar rats were randomly divided into three groups: a control group (injected with normal saline), a model group (injected with D-galactosamine/lipopolysaccharide, D-Gal/LPS), and an inhibitor group (injected with D-Gal/LPS + SB203580). Each group was further divided into three subgroups for testing at different time points, with 8 rats in each subgroup. Blood samples were collected for the determination of alanine aminotransferase (ALT) and total bilirubin (TBIL). HE staining was performed to observe the liver pathological changes. Immunohistochemical assay was performed to detect the expression of Caspase12 protein. The diphenylamine method was used to detect the apoptosis rate.

RESULTS: The liver function, Caspase12 protein expression and apoptosis rate in the inhibitor group at 12 h were lower than those in the model group. Caspase12 protein expression at 18 h in the inhibitor group had no significant difference with that in the model group, while the apoptosis rate was significantly higher in the inhibitor group than in the model group. Necrosis occurred in the model group at 12 h, and in the inhibitor group at 18 h.

CONCLUSION: P38MAPK inhibitor SB203580 can reduce the expression of Caspase12 protein, inhibit the endoplasmic reticulum stress-mediated hepatocyte apoptosis, reduce the necrosis of liver cells and play a protective effect against acute hepatic failure.