肝功能不全病人原位肝移植围术期脑氧代谢的特点.doc

肝功能不全病人原位肝移植围术期脑氧代谢的特点 蔡 珺，孙海云，关健强，黑子清 （中山大学附属第三医院麻醉科，广州，510630） [摘要] 目的 观察肝硬化不同程度肝功能损害病人肝移植围术期脑氧代谢的特点。方法 选择行肝移植手术的33例患者，按肝功能Chind分级分成A组（A级10例），B组（B级13例），C组（C级10例），于术前（T1），无肝25分钟(T2)，新肝30分钟(T3)，新肝3小时(T4)，新肝24小时(T5)，抽取桡动脉和左颈静脉球部血，进行血气分析，计算动脉血氧含量(CaO2)，颈静脉血氧含量(CjvO2)，动脉-颈静脉血氧含量差(Ca-jvO2)，脑氧摄取率(CERO2)，脑血流/脑氧代谢比值(CBF/CMRO2)。结果 脑氧代谢指标三组整体变化趋势一致，Ca-jvO2 和CERO2无肝期、新肝期较术前显著降低（P0.05），新肝24小时恢复术前水平(P0.05)；SjvO2和CBF/CMO2无肝期、新肝期较术前显著增高（P0.05），新肝24小时恢复术前水平(P0.05)； Ca-jvO2 和CERO2在术前期，B组和C组都较A组显著降低（P0.05），无肝期、新肝期C组较A组和B组显著降低（P0.05），新肝24小时组间比较差异不显著(P0.05)；SjvO2术前期B组和C组都较A组显著增高（P0.05），其余时间点组间比较差异不显著(P0.05)；CBF/CMO2在术前期B组和C组都较A组显著增高（P0.05），无肝期、新肝期C组较A组和B组显著增高（P0.05），新肝24小时组间比较差异不显著(P0.05)。结论 肝硬化病人肝移植围术期脑氧耗降低，脑氧供增高，供需失衡与肝功能损害程度有关。 [关键词] 肝移植；肝硬化；脑氧耗；脑氧供 Cerebral oxygen metabolism during orthotopic liver transplantation in patients with hepatic insufficiency. CAI jun, SUN hai-yun, GUAN jian-qiang, HEI Zi-qing. .Department of Anesthesiology, Third Affiliated Hospital, Sun Yat-sen University, Guang Zhou 510630, China. [Abstract]：Objective To investigate the feature of cerebral oxygen metabolism during orthotopic liver transplantation(OLT) in liver cirrhoses patients with different degreen of hepatic insufficiency. Methods Thirty-three patients undergoing OLT were divided into three groups(A group, B group, C group) according to the clinic grading of liver function (Child method). Blood Samples were taken from radial artery and jugular bulb simultaneously for blood gas analysis before operation(T1, baseline), 25 min after onset of anhepatic phase(T2), 30 min after graft reperfusion(T3), 3h after graft reperfusion(T4) and 24h after graft reperfusion(T5). Cerebral arteral oxygen content(CaO2), Oxygen content of jugular bulb blood(CjvO2),Cerebral arterial-venous oxygen content difference(Ca-jvO2), Cerebral oxygen extractior ratio(CERO2) and CBF/CMRO2 were calculated. Results Ca-jvO2 and CERO2 were significantly decreased at T2, T3 and T4（P0.05）, but no significant difference at T5 (P0