右美托咪定对亲体肝移植患儿术后脑损伤的影响

Effect of dexmedetomidine on postoperative brain injury in pediatric patients undergoing living-related liver transplantation

目的评价右美托咪定对亲体肝移植患儿术后脑损伤的影响。方法择期拟行亲体肝移植术患儿40例，ASA分级Ⅲ或Ⅳ级，年龄5～12月，性别不限，体重5～10 kg，采用随机数字表法分为2组（n＝20）：右美托咪定组（D组）和对照组（C组）。D组麻醉诱导后静脉给予右美托咪定负荷剂量1 μg/kg，持续泵注10 min，随后以0.3 μg·kg－1·h－1持续泵注；C组给予等容量生理盐水。分别于切皮即刻（T1）、无肝期30 min（T2）、新肝期1 h（T3）、关腹即刻（T4）和术后24 h（T5）时采集中心静脉血样，采用ELISA法检测血清神经元烯醇化酶（NSE）和S-100β蛋白的浓度，术后1 d时采用儿童麻醉苏醒期谵妄评分量表（PAED）评价术后谵妄的发生情况，于术前1 d和术后1周采用贝利婴幼儿发展量表记录患儿智力发展指数（MDI）和运动发展指数（PDI）。结果与T1时比较，2组患儿T2～5时血清NSE和S-100β蛋白浓度升高（P〈0.05）；与C组比较，D组T2～5时血清NSE和S-100β蛋白浓度降低，PAED评分和谵妄发生率降低（P〈0.05）；与术前1 d时比较，2组患儿术后1周时MDI和PDI降低（P〈0.05）；D组术后1周时MDI较C组升高（P〈0.05）。结论右美托咪定可减轻亲体肝移植患儿术后脑损伤。

Objective To evaluate the effect of dexmedetomidine on postoperative brain injury in pediatric patients undergoing living-related liver transplantation. Methods Forty American Society of Anesthesiologists physical status Ⅲ or Ⅳ pediatric patients of both sexes, aged 5-12 months, weighing 5-10 kg, were divided into dexmedetomidine group （ group D, n = 20） and control group （ group C, n = 20） using a random number table. After induction of anesthesia, dexmedetomidine was infused in a loading dose of 1 μg/kg for 10 min followed by a continuous infusion of 0.3 μg · kg-1 · h-1 in group D. The equal volume of normal saline was given instead in group C. Immediately before skin incision （T1 ） , at 30 min of anhepatic phase （T2） , at 1 h of neohepatic phase （ T3 ）, immediately after peritoneum closure （ T4 ） and at 24 h after operation （ T5 ）, the blood samples were collected from the central vein to detect the concentrations of neuron-specific enolase （NSE） and S-10013 protein in serum by enzyme-linked immunosorbent assay. Postoperative delirium was assessed at 1 day after surgery using Pediatric Anesthesia Emergence Delirium scale. At 1 day before surgery and 1 week after surgery, the Mental Development Index （MDI） and Psy-chomotor Development Index were recorded using Bayley Scale of Infant Development Ⅱ Results The concentrations of serum NSE and S-10013 protein were significantly higher at T2-5 than at T1 in the two groups （P〈0.05）. Compared with group C, the concentrations of serum NSE and S-10013 protein were significantly decreased at T2-5 , and the Pediatric Anesthesia Emergence Delirium scale score and incidence of delirium were decreased after surgery in group D （P〈0.05）. The MDI and Psychomotor Development Index were significantly lower at 1 week after surgery than at 1 day before surgery in the two groups （P〈0.05）. The MDI was significantly higher at 1 week after surgery in group D than in group C （P〈0.05）. Conclusion Dexmedetomidine can reduce postoperative brain injury in pediatric patients undergoing living-related liver transplantation.