不同麻醉方法对胆道闭锁患儿亲体肝移植术围术期肺损伤影响的比较  

Comparison of effects of different anesthesia methods on perioperative lung injury in pediatric patients with biliary atresia undergoing living donor liver transplantation

作　　者：丁梅[1] 裴平 翁亦齐[1] 刘伟华[1] 张桂诚 盛明薇[1] 于辉 喻文立[1] Ding Mei;Pei Ping;Weng Yiqi;Liu Weihua;Zhang Guicheng;Sheng Mingwei;Yu Hui;Yu Wenli(Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China;Department of Surgery,Nankai University Affiliated Hospital(Tianjin Fourth Hospital),Tianjin 300222,China)

机构地区：[1]天津市第一中心医院麻醉科,天津300192 [2]南开大学附属医院(天津市第四医院)外科,天津300222

出　　处：《中华麻醉学杂志》2023年第11期1292-1297,共6页Chinese Journal of Anesthesiology

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-045A);天津市卫生健康委员会科技项目(ZC20223)。

摘　　要：目的比较不同麻醉方法对胆道闭锁患儿亲体肝移植术围术期肺损伤的影响。方法选择择期行亲体肝移植术的胆道闭锁患儿91例, 性别不限, 年龄0~36个月, ASA分级Ⅰ~Ⅲ级, 心功能分级Ⅰ或Ⅱ级, Child-Pugh分级B或C级, 按照麻醉方法分为3组:丙泊酚复合麻醉组(P组, n=30)、七氟烷复合麻醉组(S组, n=30)和丙泊酚-七氟烷复合麻醉组(PS组, n=31)。P组静脉输注1%丙泊酚9~15 mg·kg^(-1)·h^(-1);S组吸入七氟烷, 维持呼气末浓度2.6%~4.0%;PS组静脉输注1%丙泊酚9~15 mg·kg^(-1)·h^(-1), 吸入七氟烷, 维持呼气末浓度1.0%~2.5%。3组术中静脉输注瑞芬太尼0.1~1.0 μg·kg^(-1)·min^(-1)镇痛, 静脉输注苯磺酸顺阿曲库铵1~2 μg·kg^(-1)·min^(-1)维持肌松。分别于麻醉诱导后即刻(T_(0))、手术开始60 min (T_(1))、无肝期10 min (T_(2))、门静脉开放60 min (T_(3))和关腹即刻(T_(4))时, 采用ELISA法检测血清克拉拉细胞分泌蛋白16(CC16)、表面活性蛋白(SP-D)、高级糖基化终末产物可溶性受体(s-RAGE)、高迁移率族蛋白B1(HMGB1)、TNF-α和IL-1β的浓度, 同时记录肺顺应性(Cdyn)。分别于T_(0)-T_(4)及术后24 h(T_(5))时, 行动脉血气分析, 计算氧合指数(OI)和呼吸指数(RI)。分别于术前24 h及T_(5)时, 行肺部超声评分(LUS评分)。记录术后7 d内肺部并发症发生情况。观察术后半年生存情况。结果 S组和P组各时点血清CC16、SP-D和s-RAGE浓度、LUS评分比较差异无统计学意义(P>0.05);与S组和P组比较, PS组T_(3)时血清CC16浓度和T_(3), 4时血清s-RAGE浓度降低, T_(5)时C评分和B评分降低(P<0.05)。3组不同时点血清HMGB1、IL-1β和TNF-α浓度、Cydn、术后7 d内ALI/ARDS、肺部感染、胸腔积液、肺不张发生率比较差异无统计学意义(P>0.05)。3组患儿术后半年生存率均为100%。结论丙泊酚-七氟烷复合麻醉减轻胆道闭锁患儿肝移植术围术期肺损伤的效果优于丙泊酚复合麻醉和七氟烷复合麻醉�Objective To compare the effects of different anesthesia methods on perioperative lung injury in pediatric patients with biliary atresia undergoing living donor liver transplantation.Methods Ninety-one American Society of Anesthesiologists Physical Status classificationⅠ-Ⅲpediatric patients with biliary atresia,regardless of gender,aged 0-36 months,with cardiac function grade ofⅠorⅡand Child-Pugh grade of B or C,undergoing elective living donor liver transplantation,were selected.According to the anesthesia method,the pediatric patients were divided into 3 groups:propofol-based anesthesia group(P group,n=30),sevoflurane-based anesthesia group(S group,n=30)and propofol-sevoflurane-based anesthesia group(PS group,n=31).Group P received intravenous infusion of 1%propofol 9-15 mg·kg^(-1)·h^(-1).In group S,sevoflurane was inhaled and the end-tidal concentration was maintained at 2.6%-4.0%.In PS group,1%propofol 9-15 mg·kg^(-1)·h^(-1) was intravenously infused and sevoflurane was inhaled,maintaining an end-tidal concentration at 1.0%-2.5%.Remifentanil 0.1-1.0μg·kg^(-1)·min^(-1) was intravenously infused during operation for analgesia,and cisatracurium besylate 1-2μg·kg^(-1)·min^(-1) was intravenously infused to maintain muscle relaxation in three groups.Immediately after anesthesia induction(T_(0)),at 60 min after start of surgery(T_(1)),at 10 min of anhepatic phase(T_(2)),at 60 min after portal vein opening(T_(3)),and immediately after abdominal closure(T_(4)),the concentrations of serum Clara cell secretory protein 16(CC16),surfactant protein(SP-D),soluble receptors for advanced glycation end products(s-RAGE),high mobility group protein B1(HMGB1),tumor necrosis factor-alpha(TNF-α)and interleukin^(-1)beta(IL-1β)were measured using enzyme-linked immunosorbent assay method,and lung compliance(Cdyn)was simultaneously recorded.At T_(0)-T_(4) and 24 h after surgery(T_(5)),the arterial blood gas analysis was performed to calculate the oxygenation index(OI)and respiratory index(RI).Lung ultrasound scores(

关 键 词：丙泊酚 七氟醚 肝移植 急性肺损伤 儿童 胆道闭锁 

分 类 号：R726.1[医药卫生—儿科]