Abstract:

Objective To evaluate the effects of propofol on brain during pediatric parent livertransplantation. Methods 40 pediatric patients in Tianjin First Central Hospital with congenital biliary atresia wereprepared to do elective parent liver transplantation. There was no gender perference，age from six to nine months，their weight was from 6 to 9.5 kg，and ASA classification was Ⅲ or Ⅳ grade. They were randomly divided into two groups （n ＝ 20）：propofol group（P group）and control group（C group）. Their vein were opened after entering into operating room. They were injected with atropine 0.01 mk/kg，midazolam 0.10-0.15 mg/kg，etomidate 0.2-0.3 mg/kg，fentany 2-5 μg/kg and vecuronium 0.8-1.0 mg/kg through the venous pathway. They were carried out endotrachealintubation and mechanical ventilation after induction of anesthesia. Propofol were continuously pump-injected9-15 mg/（kg·h）until the end of the surgery in P group. 1%-2% sevoflurane were continuously inhaled in C group. Their blood samples were collected from central venous at the time of operation began（T0），30 min after anhepatic phase（T1），3 hours after hepato-reperfusion（T2），24 hours after hepato-reperfusion（T3）. S100-β expression and neuron-specific enolase（NSE）were detected. Results There were no significant difference in basic information of pediatric patients（age，weight，anhepatic phase，anesthsic time，operationtime，transfusion volume and urine volume）. Compared with T0，the concentration of S100-βand NSE were in serum increased at T1，T2 in P and C groups〔C group，S100-β（ng/ml）：11.29±3.45、8.66±1.57 vs. 5.26±0.94，P ＜ 0.05，NSE（ng/ml）：26.92±4.43、24.57±4.12 vs. 20.68±2.94，P ＜ 0.05 ；P group ：S100-β（ng/ml）：9.28±1.85、6.47±0.86 vs. 4.91±1.25，P ＜ 0.05，NSE（ng/ml）：24.50±3.26、22.23±3.07 vs. 19.89±4.40，P ＜ 0.05〕. Compared with C group，the concentration of serum S100-βand NSE were decreased in P group at T1-T3〔S100-β（ng/ml）：9.28±1.85 vs. 11.29±3.45、6.47±0.86 vs. 8.66±1.57、5.49±0.79 vs. 6.36±1.42，P ＜ 0.05 ；NSE（ng/ml）：24.50±3.26 vs. 26.92±4.43、22.23±3.07 vs. 24.57±4.12、20.04±20.71 vs. 21.94±3.07，P ＜ 0.05〕. Conclusion Propofol can alleviate brain injury during pediatric parent liver transplantation.

摘要：

目的 评价异丙酚对亲体肝脏移植患儿脑损伤的影响。方法 选择天津市第一中心医院40 例因先天性胆道闭锁择期行亲体肝脏移植的患儿，性别不限，年龄 6 ～ 9 个月，体重 6.0 ～ 9.5 kg，ASAⅢ或Ⅳ级，采用随机数字表法将其分为 2 组（n ＝ 20）：异丙酚组（P 组）和对照组（C 组）。入室后开放静脉通路，静脉注射阿托品 0.01 mg/kg，咪达唑仑 0.10 ～ 0.15 mg/kg，依托咪酯 0.2 ～ 0.3 mg/kg，芬太尼 2 ～ 5 μg /kg和维库溴铵0.8～1.0 mg/kg。麻醉诱导后气管插管，行机械通气，P组持续泵注异丙酚9～15 mg /（kg·h）至术毕，C 组持续吸入 1% ～ 2% 七氟烷至术毕。分别于切皮即刻（T0）、无肝期 30 分钟（T1）、新肝期 3 小时（T2）、新肝期 24 小时（T3）时取中心静脉血，检测血清星形胶质源性蛋白（S100-β）和神经元 特异性烯醇化酶（NSE）。结果 两组患儿基本情况（年龄、体重、无肝期、麻醉时间、手术时间、输血 量、尿量）无显著差异（P ＞ 0.05）。两组患儿 T1、T2 时间点的 S100-β 和 NSE 水平均比 T0 时有所升高 〔C 组，S100-β（ng/ml）：11.29±3.45、8.66±1.57 比 5.26±0.94，P ＜ 0.05，NSE（ng/ml）：26.92±4.43、24.57±4.12 比 20.68±2.94，P ＜ 0.05 ；P 组 ：S100-β（ng/ml）：9.28±1.85、6.47±0.86 比 4.91±1.25，P ＜ 0.05，NSE（ng/ml）：24.50±3.26、22.23±3.07 比 19.89±4.40，P ＜ 0.05〕；与 C 组比较，P 组 T1 ～ T3 时间点 S100-β 和 NSE 水平均下降，并且差异具有统计学意义〔S100-β（ng/ml）：9.28±1.85 比 11.29±3.45、6.47±0.86 比 8.66±1.57、5.49±0.79 比 6.36±1.42，P ＜ 0.05 ；NSE（ng/ml）：24.50±3.26 比 26.92±4.43、22.23±3.07 比 24.57±4.12、20.04±20.71 比 21.94±3.07，P ＜ 0.05〕。结论 异丙酚可减轻亲体肝脏移植患儿的脑损伤程度。