肝脏缺血再灌注对患者术后短期认知功能的影响

Influence of hepatic ischemia-reperfusion on short-term cognitive function

目的评价肝脏缺血再灌注对患者术后短期认知功能的影响。方法拟在全麻下行肝脏部分切除术患者30例，性别不限，年龄18～60岁，心功能分级Ⅰ或Ⅱ级，肝功能分级A级，ASA分级I或Ⅱ级。采用随机数字表法，将患者随机分为2组（n=15）：未阻断肝门组（c组）和阻断肝门组（I／R组）。术中采取全凭静脉麻醉，维持脑电双频谱指数值40～60。分别于术前1d（基础状态）、术后7d进行神经心理学测试，计算基础值与术后成绩的差值，记录认知功能障碍的发生情况。结果与c组比较，I／R组累加测试、数字符号测试、循迹连线测试B与倒背数字广度测试成绩的基础值与术后成绩差值升高（P〈0．05或0．01），其他神经心理学测试成绩的基础值与术后成绩差值差异无统计学意义（P〉0．05）。c组和I／R组术后认知功能障碍的发生率分别为20％和87％，I／R组高于c组（P〈0．05）。肝门阻断时间与认知功能障碍的发生无相关性（P〉0．05）。结论肝脏缺血再灌注可增加术后短期认知功能障碍的发生，但缺血时间与POCD的发生无关。

Objective The investigate the influence of hepatic ischemia-reperfusion （I/R） on short-term postoperative cognitive function. Methods Thirty ASA Ⅰ or n （Child-Pugh A, NYHA class Ⅰ or Ⅱ ） patients of both sexes aged 18-60 yr undergoing partial hepateetomy under general anesthesia were randomly divided into 2 groups （n = 15 each） ： control group--hepatic portal was not clamped （group C） and I/R group--hepatic portal was clamped. Anesthesia was induced with midazolam, propofol, sufentanil and cis-atracurium and maintained with propofol TCI （Cp = 2-4 μg/ml） and intermittent iv boluses of sufentanil and cis-atracurium. The patients were me- chanically ventilated after tracheal intubafion. PETCO： was maintained at 35-40 mm Hg. BIS value was maintained at 40-60 during operation. The cognitive function was assessed at 1 day before and 7 days after operation using comprehensive neuro-psychological tests and scored. Results The differences between preoperative and postoperative values of accumulate test, number sign test, trail marking test B and digit span backward test were significantly higher in group I/R than in group C. However, there were no significant differences in trail marking test A, digit span forward test or clock drawing test between the 2 groups. The incidence of postoperative cognitive dysfunction （POCD） was 20 % in group C and 87 % in group I/R. Duration of hepatic portal clamping was not correlated with incidence of POCD. Conclusion Hepatic I/R can increase the incidence of short-teml POCD but the incidence of POCD is not related to the duration of hepatic ischemia.