Abstract:

Objective　To investigate the effects of different oxygen delivery (DO₂) directed hemodynamic management on perioperative cerebral function in patients undergoing liver transplantation. Methods　Forty patients scheduled for liver transplantation in 970th Hospital of People's Liberation Army from January 2019 to December 2019 were selected for the random control trial, including 28 males and 12 females; they were 34-64 yeas old. They were randomly divided to a control group and an experimental group, with 20 cases in each group. The control group received common hemodynamic management; the DO₂ during operation was maintain between 350～500 ml·min^-1·m^-2. The experimental group received DO₂ directed hemodynamic management; the DO₂ were maintained above 500 ml·min^-1·m^-2. Arterial blood samples were obtained after induction of anesthesia and before surgery (T₀), at 30 min of anhepatic phase (T₁), 30 min after neohepatic phase (T₂), at the ending of surgery (T₃), 24 h after surgery (T₄), and 48 h after surgery (T₅) for the determination of serum S100β protein (S100β) and neuron-specific enolase(NSE) concentrations in both groups. The regional cerebral oxygen saturation (rSO₂) was monitored by near-infrared spectroscopy at T₀, T₁ , T₂, and T₃. The cognitive function was assessed by Mini Mental State Scale (MMSE) 1 d before and 3, 5, and 7 d after surgery. χ² and t tests were applied. Results　The S100β and NSE concentrations at T₂ and T₃ and after the surgery were significantly higher than those at T₀ in both groups. The concentrations of S100β at T₂, T₃, T₄, and T₅ and the concentrations of NSE at T₂, T₃, and T₄ in the experimental group were significantly lower than those in the control group (t=6.268, 4.396, 4.245, 7.615, 2.172, 8.619, and 3.555; all P<0.05). Compared with those at T₀, the rSO₂ at T₁ in both groups were significantly lower; the rSO₂ at T₁ in the experimental group was significantly lower than that in the control group (t=-13.136,P<0.05). Conclusions　The DO₂ directed hemodynamic management can improve the cerebral oxygen metabolism during surgery in the patients undergoing liver transplantation, decrease the levels of S100βand NSE in serum and the incidence of postoperative cognitive dysfunction, and protect their cerebral function.

Key words:

Liver transplantation, Oxygen delivery, rSO₂, Neuron-specific enolase, S100β, Cerebral protection

摘要：

目的　探讨术中不同氧供（DO₂）水平的血流动力学管理模式对肝移植患者脑功能的影响。方法　选择2017年1月至2019年12月在解放军第九七〇医院进行肝脏移植手术患者40例进行随机对照试验，男28例，女12例，年龄34～64岁，患者随机被分为对照组和试验组，每组20例。对照组为常规血流动力学管理，维持术中DO₂在350～500 ml·min^-1·m^-2；试验组以DO₂为导向血流动力学管理，维持DO₂≥500 ml·min^-1·m^-2。两组患者于麻醉后手术前（T₀）、无肝期30 min（T₁）、新肝期30 min（T₂）、术毕（T₃）术后24 h（T₄）、术后48 h（T₅）分别抽取动脉血检测血清S100β蛋白（S100β）和神经元特异性烯醇化酶（NSE）浓度。分别于无肝前期（T₀）、无肝期（T₁）、新肝期（T₂）和术毕（T₃）使用近红外光谱的脑氧饱和度监测仪监测记录局部脑氧饱和度（rSO₂）。分别于术前1 d、术后第3、5、7 天用简易智力状态检查量表（MMSE）评估患者认知功能。统计学方法采用χ²检验、t检验。结果　与T₀比较，两组患者血清S100β和NSE浓度在T₂、T₃以及术后各时点明显上升。试验组S100β在T₂、T₃、T₄、T₅和NSE浓度在T₂、T₃、T₄均明显低于对照组（t=6.268、4.396、4.245、7.615、2.172、8.619、3.555，均P<0.05）。与T₀比较，两组患者T₁时rSO₂均明显下降；与对照组比较，试验组T₁时rSO₂明显高于对照组（t=-13.136，P<0.05）。结论　以DO₂为导向的血流动力学管理模式可促进肝移植患者术中脑氧代谢，降低患者术后血清S100β与NSE浓度，降低术后认知功能障碍发生，对肝移植患者围术期的脑功能具有保护作用。

关键词:

肝移植, 氧供, 脑氧饱和度, 神经元特异性烯醇化酶, S100β, 脑保护