吉林大学学报(医学版) ›› 2021, Vol. 47 ›› Issue (1): 168-172.doi: 10.13481/j.1671-587x.20210123

• 临床研究 • 上一篇    下一篇

亲体肝移植患儿围术期血清中脑损伤标志物水平的变化及临床意义

于洪丽,喻文立(),翁亦齐,刘伟华,孙英,刘云霞   

  1. 天津市第一中心医院麻醉科, 天津 300192
  • 收稿日期:2020-05-07 出版日期:2021-01-28 发布日期:2021-01-27
  • 通讯作者: 喻文立 E-mail:yzxyuwenli@163.com
  • 作者简介:于洪丽(1985-),女,天津市人,主治医师,主要从事肝移植围术期器官保护方面的研究。
  • 基金资助:
    国家自然科学基金青年基金项目(81700659);天津市科技局自然科学基金面上项目(18JCYBJC27500);天津市医学会麻醉学分会青年科研基金项目(TJMZJJ-2018-01)

Changes in levels of brain injury markers in serum during perioperative period in infants underwent parent liver transplantation and their clinical significances

Hongli YU,Wenli YU(),Yiqi WENG,Weihua LIU,Ying SUN,Yunxia LIU   

  1. Department of Anesthesiology,Tianjin First Central Hospital,Tianjin 300192,China
  • Received:2020-05-07 Online:2021-01-28 Published:2021-01-27
  • Contact: Wenli YU E-mail:yzxyuwenli@163.com

摘要: 目的

探讨亲体肝移植患儿围术期血清中神经元特异性烯醇化酶(NSE)和星形胶质源性蛋白S-100β蛋白水平的变化,阐明其与亲体肝移植围术期患儿脑损伤的关系。

方法

选取接受亲体肝移植术的胆道闭锁患儿40例,4~12月龄,体质量3.0 ~10.0 kg,美国麻醉医师协会(ASA)分级Ⅲ或Ⅳ级。分别于麻醉后切皮即刻(T1)、无肝期30 min(T2)、新肝期1 h(T3)和新肝期24 h(T4)采集患儿右颈内静脉血,记录各时间点心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)和外周血pH值, 采用ELISA法检测患儿血清中NSE和S-100β蛋白水平。

结果

患儿无肝期和新肝期血流动力学发生明显变化,与T1时比较,T2时患儿HR增加(P<0.05),MAP、CVP和外周血pH值降低(P<0.05),术毕各项指标均降至术前水平。与T1时比较,T2~T4时患儿血清中NSE和S-100β蛋白水平均升高(P<0.01);与T2时比较,T3时患儿血清中NSE和S-100β蛋白水平均明显升高(P<0.05);与T3时比较,T4时NSE和S-100β蛋白水平明显降低(P<0.05)。

结论

亲体肝移植手术患儿围术期存在脑损伤,手术过程中脑损伤逐步加重,于术后24 h逐渐恢复至术前水平。

关键词: 亲体肝移植, 儿童, 脑损伤, 神经元特异性烯醇化酶, S-100β蛋白

Abstract: Objective

To investigate the changes in the levels of serum neuron specific enolase (NSE) and serum S-100β protein during the perioperative period in the infants underwent parent liver transplantation, and to clarify the relationships between NSE, S-100β and brain injury during the perioperative period of the infants underwent parent liver transplantation.

Methods

Forty infants with congenital biliary atresia underwent parent liver transplantation were selected, aged 4-12 months, weighing 3.0-10.0 kg, ASA status Ⅲ or Ⅳ class. The blood samples were drawn from central vein of the infants before skin incision (T1), 30 min after anhepatic phase (T2), 1 h after neohepatic phase (T3) and 24 h after neohepatic stage (T4). Furthermore, the heart rate (HR), the mean arterial blood pressure(MAP), the central venous pressure(CVP),and pH values of blood were monitored at the moments of T1-T 4. The serum S-100β and NSE levels were detected by ELISA method.

Results

The levels of hemodynamics were significantly changed in anhepatic phase and neohepatic phase;compared with T1,the HR at T2 of the infants was accelerated (P<0.05),and the MAP, CVP and pH value of blood were decreased (P<0.05). After the surgery, all the hemodynamic indexes fell to the preoperative levels. Compared with T1, the serum NSE and S-100β levels at T2-T 4 of the infants were decreased (P<0.05); compared with T2, the serum S-100β and NSE levels of the infants at T3 of the infants were significantly increased (P<0.05); compared with T3,the serum S-100β and NSE levels at T4 of the infants were significantly decreased (P<0.05).

Conclusion

The brain injury may appear during the perioperative in the infants underwent parent liver transplantation and gradually aggravates during the anhepatic phase and gradually returns to the preoperative levels at 24 h after surgery.

Key words: parent liver transplantation, infant, brain injury, neuron specific enolase, S-100β protein

中图分类号: 

  • R657.3