首页> 中文期刊>中华危重病急救医学 >肝移植术后脑病患者围手术期脑氧代谢的特点

肝移植术后脑病患者围手术期脑氧代谢的特点

摘要

Objective To investigate the feature of cerebral oxygen metabolism during peri-operative stage of orthotopic liver transplantation(OLT),in order to identify the difference between the patients with or without complicating encephalopathy after OLT,and the relationship between the cerebral oxygen metabolism and encephalopathy after OLT.Methods Thirty patients undergoing OLT were studied.The patients were divided into two groups according to occurrence or not of encephalopathy after OLT:encephalopathy group and non-encephalopathy group. Blood samples were taken from radial artery and jugular vein simultaneously for blood gas analysis before operation,25 minutes after onset of anhepatic phase,30 minutes after graft reperfusion,3 hours after graft reperfusion,and 24 hours after graft reperfusion.Cerebral arterial oxygen content(CaO2),oxygen content of jugular vein blood(CjvO2),cerebral arterial-venous oxygen content difference(Ca-jvO2),cerebral oxygen extraction ratio(CERO2)and cerebral blood flow/cerebral metabolic rate of oxygen ratio(CBF/CMRO2)were calculated,and the levels of blood glucose and lactic acid were recorded.Results There were 11 patients(36.7%)complicated by encephalopathy after OLT.The quantity of red blood cell infusion,blood loss and the dosage of noradrenalin in encephalopathy group were significantly larger compared with non-encephalopathy group.The overall tendency of change in cerebral oxygen metabolism index was about the same for both groups,while CaO2 and Ca-jvO2 at 25 minutes after onset of anhepatic phase,30 minutes after graft reperfusion and 3 hours after graft reperfusion,and CERO2 at 30 minutes after graft reperfusion and 3 hours after graft reperfusion were significantly decreased compared with those before operation(CaO2(ml/L)in encephalopathy group:132.4±23.5,125.9±17.6,133.4±11.1 vs.148.5±28.8,in non-encephalopathy group:135.7±22.4,130.5±20.0,139.9±21.2 vs.148.9±28.2; Ca-jvO2(ml/L)in encephalopathy group: 42.9±13.2,31.4±12.3,32.3±6.5 vs.52.9±23.5,in non-encephalopathy group:33.0±14.1,26.6±9.1,30.6±10.3 vs.50.2±23.2; CERO2 in encephalopathy group:(24.9±9.7)%,(24.4±5.5)%vs.(35.4±11.5)%,in non-encephalopathy group:(20.6±7.3)%,(21.9±7.0)%vs.(33.4±13.1)%,all P<0.05],and they returned to the levels before operation at 24 hours after graft reperfusion.Jugular venous oxygen saturation(SjvO2)and CBF/CMRO2 ratio were significantly increased at 30 minutes after graft reperfusion and 3 hours after graft reperfusion compared with the levels before operation [SjvO2 in encephalopathy group:0.838±0.105,0.835±0.065 vs.0.709±0.125,in non-encephalopathy group:0.854±0.074,0.824±0.074 vs.0.713±0.138;CBF/CMRO2 ratio in encephalopathy groupl 37.8±16.6,31.9±6.8 vs.20.9±6.7,in non-encephalopathy group:37.8±14.1,35.7±13.7 vs.24.3±14.0,all P<0.05],and they returned to the levels before operation at 24 hours after graft reperfusion.The overall tendency of change in blood glucose and lactic acid was about the same in both groups,while the levels of blood glucose increased significantly from anhepatic phase to 24 hours after graft reperfusion compared with the levels before operation,and the levels of lactic acid increased significantly from anhepatic phase to 3 hours after graft reperfusion compared with the levels before operation and returned to the levels before operation at 24 hours after graft reperfusion.Conclusion There are significant changes in the features of cerebral oxygen metabolism during OLT,but there is no difference between encephalopathy group and non-encephalopathy group.The occurrence of encephalopathy can be attributed to many factors,so the prevention and treatment should be comprehensive considered.%目的 观察肝移植患者围手术期脑氧代谢指标变化的规律,分析术后并发脑病者的脑氧代谢特点及与术后脑病发生的关系.方法 观察并追踪肝移植患者30例,根据术后是否发生脑病分为两组,分别于术前、无肝25 min及新肝30 min、新肝3 h、新肝24 h抽取桡动脉和左颈静脉血进行血气分析,计算动脉血氧含量(CaO2)、颈静脉血氧含量(CjvO2)、动脉-颈静脉血氧含量差(Ca-jvO2)、脑氧摄取率(CERO2)、脑血流量/脑氧代谢率比值(CBF/CMRO2)等脑氧代谢指标,同时测定血糖、乳酸含量.结果 30例肝移植患者中有11例(占36.7%)术后出现了脑病症状.脑病组术中红细胞输入量、出血量和去甲肾上腺素用量均高于非脑病组.两组脑氧代谢指标整体变化趋势一致,CaO2、Ca-jvO2在无肝25 min、新肝30 min、新肝3 h时,CERO2在新肝30 min、新肝3 h时均较术前显著降低[CaO2(ml/L):脑病组132.4±23.5、125.9±17.6、133.4±11.1比148.5±28.8,非脑病组135.7±22.4、130.5±20.0、139.9±21.2比148.9±28.2;Ca-jvO2(ml/L):脑病组42.9±13.2、31.4±12.3、32.3±6.5比52.9±23.5,非脑病组33.0±14.1、26.6±9.1,30.6±10.3比50.2±23.2;CERO2:脑病组(24.9±9.7)%、(24.4±5.5)%比(35.4±11.5)%,非脑病组(20.6±7.3)%、(21.9±7.0)%比(33.4±13.1)%,均P<0.05],在新肝24 h时恢复至术前水平;颈静脉血氧饱和度(SjvO2)、CBF/CMRO2比值在新肝30 min、新肝3 h时均较术前显著增高(SjvO2:脑病组0.838±0.105、0.835±0.065比0.709±0.125,非脑病组0.854±0.074、0.824±0.074比0.713±0.138;CBF/CMRO2比值:脑病组37.8±16.6、31.9±6.8比20.9±6.7,非脑病组37.8±14.1、35.7±13.7比24.3±14.0,均P<0.05),在新肝24 h时恢复至术前水平.两组血糖、乳酸含量整体变化趋势一致,血糖在无肝期至新肝24 h均较术前显著升高;乳酸含量在无肝期至新肝3 h显著高于术前,至新肝24 h时恢复至术前水平.结论 肝移植围手术期脑氧代谢发生异常变化,但脑病组并无特异性.肝移植术后脑病的发生是多因素的,预防和治疗上要综合考虑.

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