摘要
目的评价异丙酚对亲体肝脏移植患儿脑损伤的影响。方法选择天津市第一中心医院40例因先天性胆道闭锁择期行亲体肝脏移植的患儿,性别不限,年龄6~9个月,体重6.0~9.5 kg,ASAⅢ或Ⅳ级,采用随机数字表法将其分为2组(n=20):异丙酚组(P组)和对照组(C组)。入室后开放静脉通路,静脉注射阿托品0.01 mg/kg,咪达唑仑0.10~0.15 mg/kg,依托咪酯0.2~0.3 mg/kg,芬太尼2~5μg/kg和维库溴铵0.8~1.0 mg/kg。麻醉诱导后气管插管,行机械通气,P组持续泵注异丙酚9~15 mg/(kg·h)至术毕,C组持续吸入1%~2%七氟烷至术毕。分别于切皮即刻(T0)、无肝期30分钟(T1)、新肝期3小时(T2)、新肝期24小时(T3)时取中心静脉血,检测血清星形胶质源性蛋白(S100-β)和神经元特异性烯醇化酶(NSE)。结果两组患儿基本情况(年龄、体重、无肝期、麻醉时间、手术时间、输血量、尿量)无显著差异(P>0.05)。两组患儿T1、T2时间点的S100-β和NSE水平均比T0时有所升高〔C组,S100-β(ng/ml):11.29±3.45、8.66±1.57比5.26±0.94,P<0.05,NSE(ng/ml):26.92±4.43、24.57±4.12比20.68±2.94,P<0.05;P组:S100-β(ng/ml):9.28±1.85、6.47±0.86比4.91±1.25,P<0.05,NSE(ng/ml):24.50±3.26、22.23±3.07比19.89±4.40,P<0.05〕;与C组比较,P组T1~T3时间点S100-β和NSE水平均下降,并且差异具有统计学意义〔S100-β(ng/ml):9.28±1.85比11.29±3.45、6.47±0.86比8.66±1.57、5.49±0.79比6.36±1.42,P<0.05;NSE(ng/ml):24.50±3.26比26.92±4.43、22.23±3.07比24.57±4.12、20.04±20.71比21.94±3.07,P<0.05〕。结论异丙酚可减轻亲体肝脏移植患儿的脑损伤程度。
Objective To evaluate the effects of propofol on brain during pediatric parent liver transplantation.Methods40 pediatric patients in Tianjin First Central Hospital with congenital biliary atresia were prepared to do elective parent liver transplantation. There was no gender perference, age from six to nine months, their weight was from6 to9.5 kg, and ASA classification was Ⅲ or Ⅳ grade. They were randomly divided into two groups (n=20): propofol group(P group) and control group(C group). Their vein were opened after entering into operating room. They were injected with atropine0.01 mk/kg, midazolam0.10-0.15 mg/kg, etomidate0.2-0.3 mg/kg, fentany2-5μg/kg and vecuronium0.8-1.0 mg/kg through the venous pathway. They were carried out endotracheal intubation and mechanical ventilation after induction of anesthesia. Propofol were continuously pump-injected 9-15 mg/(kg·h) until the end of the surgery in P group.1%-2% sevoflurane were continuously inhaled in C group. Their blood samples were collected from central venous at the time of operation began(T0),30 min after anhepatic phase(T1),3 hours after hepato-reperfusion(T2),24 hours after hepato-reperfusion(T3). S100-β expression and neuron-specific enolase(NSE) were detected.Results There were no significant difference in basic information of pediatric patients(age, weight, anhepatic phase, anesthsic time, operation time, transfusion volume and urine volume). Compared with T0,the concentration of S100-βand NSE were in serum increased at T1, T2 in P and C groups〔C group,S100-β(ng/ml):11.29±3.45、8.66±1.57 vs. 5.26±0.94,P<0.05,NSE(ng/ml):26.92±4.43、24.57±4.12 vs.20.68±2.94,P<0.05;P group:S100-β(ng/ml):9.28±1.85、6.47±0.86 vs.4.91±1.25,P<0.05,NSE(ng/ml):24.50±3.26、22.23±3.07 vs.19.89±4.40, P<0.05〕. Compared with C group, the concentration of serum S100-βand NSE were decreased in P group at T1-T3〔S100-β(ng/ml):9.28±1.85 vs.11.29±3.45、6.47±0.86 vs.8.66±1.57、5.49±0.79 vs.6.36±1.42, P<0.05;NSE(ng/ml):24.50±3.26 vs.26.92±4.43、22.23±3.07 vs.24.57±4.12、20.04±20.71 vs.21.94±3.07, P<0.05〕.Conclusion Propofol can alleviate brain injury during pediatric parent liver transplantation.
出处
《实用器官移植电子杂志》
2015年第6期342-345,共4页
Practical Journal of Organ Transplantation(Electronic Version)
基金
天津市卫生局科技攻关项目(13KG105)
关键词
肝移植
异丙酚
七氟烷
脑保护
Liver transplantation
Propofol
Sevoflurane
Brain protection