关键词:

 , 麻醉 , 右美托咪定 , 肝移植手术 , 炎症反应 , 认知功能障碍

Abstract:

Objective To investigate the effects of dexmedetomidine intervention on procalcitonin（PCT）， tumor necrosis factor - α（TNF - α）， helper T cell （Th17） levels， and cognitive function in patientswith decompensated cirrhosis undergoing liver transplantation surgery. Methods A total number of 72 patientswho underwent liver transplantation surgery due to decompensated cirrhosis and were treated in Shenzhen Third People's Hospital from November 2022 to November 2023 were randomly divided into a study group （D group，n ＝ 36） and a control group （NS group，n ＝ 36）. The D group received intravenous infusion of dexmedetomidine loading dose after entering theroom and maintained it until the end of the surgery， while the NS group received an equal dose of physiological saline. Basic vital signs， including mean blood pressure （MAP）， heart rate （HR），pulse oxygen saturation（SPO2 ），cardiac output（CO），and central venous pressure （CVP），5 mins before anesthesia （T1 ），5 mins after tracheal intubation （T2 ），5 mins before surgery （T3 ），5 mins before anhepatic phase （T4 ），5 mins before anhepatic phase （T5 ），5 mins before new liver phase （T6 ）， 5 mins after new liver phase （T7 ）， and at the end of surgery （T8 ）. Changes in PCT， TNF - α， and Th17 levels between two groups of patients at 24 h before surgery，24 h after surgery， and 72 h after surgery， as well as the incidence of secondary infections at 15 d after surgery were compared. At the same time， the cognitive function of the two groups of patients was evaluated using the Montreal Cognitive Assessment Scale （MMSE）24 h before and 72 h after surgery， and the total amount of vasoactive drugs during surgery，intensive care unit （ICU） stay time after surgery， and total length of hospital stay after surgery were compared between the two groups of patients. Results Compared with the NS group， there was no significant difference in basic vital signs at all time points in the D group. The PCT and Th17 levels were lower in the D group at 24 and 72 h after surgery （P ＜ 0.05）. The level of TNF - α was lower at 24 h postoperatively （P ＜ 0.05）， but there was no difference at 72 h. On postoperative day 15， there was no significant difference in the incidence of secondary infections between group D （5/36，13.89%） and group NS （7/36，19.44%）（P ＞ 0.05）. In terms of cognitive function assessment， there was no significant difference in MMSE scores between the two groups before surgery （P ＞ 0.05），and the MMSE score in group D was higher than that in group NS at 72 h after surgery （P ＜ 0.05）. Concusion The use of dexmedetomidine during general anesthesia can effectively reduce the levels of PCT， TNF - α， and Th17 after liver transplantation in patients with decompensated cirrhosis， and alleviate inflammatory reactions. Meanwhile，dexmedetomidine can also improve postoperative cognitive function. These results suggest that dexmedetomidine has potential clinical value in the prognosis of liver transplantation in the decompensated phase of hepatitis cirrhosis.

Key words:

 , Anesthesia ,  , Dexmedetomidine ,  , Liver transplantation surgery ,  , Inflammatoryresponse,  , Cognitive impairment