不同程度肝功能损害肝硬化患者肝移植围手术期脑氧代谢观测  

Cerebral oxygen metabolism during orthotopic liver transplant operation in patients with different degrees of hepatic insufficiency

作　　者：蔡珺[1] 孙海云[1] 沈宁[1] 黑子清[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广州510630

出　　处：《中华移植杂志（电子版）》2009年第4期298-301,共4页Chinese Journal of Transplantation(Electronic Edition)

基　　金：广东省科技计划资助项目(2006B36003019)

摘　　要：目的观察不同程度肝功能损害肝硬化患者肝移植围手术期脑氧代谢的变化。方法选择2006年11月至2007年3月接受肝移植的33例患者,按肝功能Child-Turcotte-Pugh分级分成A组(A级10例)、B组(B级13例)、C组(C级10例),于无肝前期开始(T1)、无肝期25min(T2)、新肝期30min(T3)、新肝期3h(T4)、新肝期24h(T5)采取桡动脉和左颈静脉球部血行血气分析,根据Fick公式计算动脉血氧含量(CaO2)、颈静脉球部血氧含量(CjvO2)、动脉-颈静脉球部血氧含量差(Ca-jvO2)、脑氧摄取率(CERO2)、脑血流/脑氧代谢比值(CBF/CMRO2)。结果3组患者脑氧代谢指标整体变化趋势一致。但T1时B、C组Ca-jvO2和CERO2较A组显著降低(均P<0.05),T2、T3、T4时C组Ca-jvO2和CERO2较A、B组显著降低(均P<0.05),T5时各组间差异无统计学意义(均P>0.05);T1时B、C组SjvO2、CBF/CMRO2均较A组均显著增高(均P<0.05);T2、T3、T4时C组CBF/CMRO2较A、B组显著增高(均P<0.05),T5时CBF/CMRO2组间差异无统计学意义(P>0.05)。结论肝硬化患者肝移植围手术期脑氧供增高、脑氧耗降低、脑氧代谢失衡程度以肝功能CTP分级C级患者最为显著。Objective To investigate the features of cerebral oxygen metabolism during orthotopic liver transplant (OLT) surgery in liver cirrhosis patients with different degrees of hepatic insufficiency.Methods Thirty-three patients underwent OLT from November 2006 to March 2007 were divided into 3 groups according to the Child-Turcotte-Pugh scores:Class A(Group A,10 patients),Class B (Group B,13 patients),and Class C(Group C,10 patients).Blood samples were taken from radial artery and jugular bulb simultaneously for blood gas analysis before operation (T_1,baseline),25 min after onset of anhepatic phase (T_2),30 min after graft reperfusion (T_3),3 h after graft reperfusion (T_4),and 24 h after graft reperfusion (T_5).Cerebral arterial oxygen content (CaO_2),jugular bulb oxygen content (CjvO_2),cerebral arterial-venous oxygen content difference(Ca-jvO_2),cerebral oxygen extraction rate(CERO_2),and cerebral blood flow/cerebral metabolic rate of oxygen (CBF/CMRO_2)were calculated by the Fick formulas.Results Ca-jvO_2 and CERO_2 in groups B and C were significantly decreased at T_1 as compared with group A(P<0.05);those in group C were significantly decreased at T_2,T_3,T_4 as compared with groups A and B(P<0.05);and no significant difference between the 3 groups at T_5 (P>0.05).SjvO_2 and CBF/CMRO_2 in groups B and C was significantly increased at T_1 as compared with group A (P<0.05);CBF/CMRO_2 in group C markedly increased at T_2,T_3,T_4 as compared with groups A and B (P<0.05);and no significant difference in CBF/CMRO_2 between the 3 groups at T_5 (P>0.05).Conclusion The unbalance of cerebral oxygen metabolism with consumption decreased and delivery increased is greater in patients with hepatic cirrhosis of CTP scores Class C.

关 键 词：肝移植 围手术期 肝硬化 脑 氧耗量 脑氧供 脑氧摄取率 脑氧代谢率 

分 类 号：R657.3[医药卫生—外科学] R614[医药卫生—临床医学]