原位肝移植术Narcotrend指数变化与早期肝功能恢复的关系

目的研究心脏死亡器官捐献(DCD)供体原位肝移植术中Narcotrend麻醉深度监测指数变化与早期肝功能恢复的关系。方法选择DCD供体原位肝移植术患者40例,在Narcotrend监测下实时调整异丙酚-瑞芬太尼靶控输注(TCI)参数,维持深度在D2~E1阶段。门静脉开放后,维持靶控参数不变,观察Narcotrend指数(NI)变化,当NI值比基础值升高超过20时,加深麻醉并记录所需时间(S)。分别于术前(T1),手术开始后1 h(T2),门静脉开放后2 h(T3)、24 h(T4)、48 h(T5)、72 h(T6)抽取静脉血检测天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血清总胆红素(TBIL)、直接胆红素(DBIL)。S值取其中位数,将高于和低于这个中位数的病例分为H、L两组进行比较。结果手术后24 h两组AST、DBIL比较差异有统计学意义(P0.05)。手术后48 h两组ALT、AST和TBIL比较差异有统计学意义(P0.05)。手术后72 h大部分指标均有所回落,H组和L组比较只有TBIL差异有统计学意义(P0.05)。结论 NI值变化趋势监测可以指导麻醉深度的调控,还能帮助我们从侧面了解DCD供肝早期恢复状况。

The relationship of the narcotrend index change and early recovery of liver function undergoing classic orthotopic liver transplantation

Objective To investigate the relationship of the narcotrend index change and early recovery of liver function undergoing classic orthotopic liver transplantation. Methods Forty patients undergoing classic orthotopic liver transplantation were anaesthetized by Propofol and remifentanil target controlled infusion （TCI）, and the depth of anesthesia was maintained by Nareotrend between D2 with E1 stage. The narcotrend index was monitored and TCI target controlled concentration remained unchanged after the portal vein opening. When the narcotrend index was rising higher than 20, anesthesia was deepened and time was recorded （S）. The six different times were selected including pro-operation （T1）, 1 hour after the operation began（T2）, 2 h after the portal vein opening（T3）, 24 h after the portal vein opening（T4）, 48 h after the portal vein opening（T5）, 72 h after the portal vein opening（T4）. ALT, AST, TBIL and DBIL were measured and average value S was calculated. The median is the middle point, where more than half of the value S is H-group and less than half is L-group. Results There were significant differences between the two groups in AST and DBIL at 24 h after the portal vein opening （P〈 0.05）. There were significant differences between the two groups in ALT, AST and TBIL at 48 h after the portal vein opening （P〈0.05）. Most of the index dropped at 72 h after the portal vein opening, but no significant differences among these groups at 72 h after the portal vein opening. There were significant differences between the H and L group in blood TBIL level. Conclusion The ascent rates of NI trend can regulate the depth of anesthesia and indicate the early recovery of liver function.