挥发性麻醉剂对肝移植早期临床结果的影响
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Impact of Volatile Anesthetic Agents on Early Clinical Outcomes in Liver Transplantation.
背景与目的
很少有研究评估吸入麻醉药在肝移植（LT）中改善缺血再灌注损伤（IRI）的能力。本研究比较了肝同种异体移植早期IRI使用的吸入麻醉药。在2001年至2015年期间，在单个中心所有LT患者中提取受体和器官捐献者数据进行回顾性分析。
方 法
在2001年至2015年期间，对单个中心的所有LT进行回顾性分析，提取LT受体和器官供体数据。主要麻醉药的选择由麻醉师决定。在移植后每天测量血清丙氨酸氨基转移酶（ALT）和总胆红素（TB）水平作为早期移植物损伤和功能的衡量。报告了生存和临床结果。
结 果
分析包括1291个早期LT患者，其中3种主要吸入剂：异氟醚（62％），地氟醚（8％）和七氟醚（30％）。在移植后的前7天，地氟醚的峰值ALT水平最低（352），其次是七氟醚（411）和异氟醚（481）（P = .09）。所有组在移植后7天具有相似的ALT和TB。所有3组的移植物存活率在第1天、第7天和第30天在统计学上相似，在1年时，相同的患者具有相同的移植物存活率。
结 论
所有3种药物的早期同种异体移植物功能障碍和肾功能障碍的发生率相似。供体移植物高风险亚组间分析显示无统计学差异。总之，地氟醚或七氟醚的给药可以提供一些针对IRI的早期肝保护作用，但是对于所有药物而言，长期结果是相同的。
原始文献摘要
BACKGROUND Few studies have assessed the ability of inhaled anesthetic agents to ameliorate ischemia-reperfusion injury (IRI) in liver transplantation (LT). This study compares inhaled anesthetics in early liver allograft IRI. LT recipient and organ donor data were extracted retrospectively for all LTs at a single center between 2001 and 2015.
METHODS LT recipient and organ donor data were extracted retrospectively for all LTs at a single center between 2001 and 2015. The choice of primary anesthetic agent was at the discretion of the anesthesiologist. Serum alanine aminotransferase (ALT) and total bilirubin (TB) levels were measured daily in the post-transplant period as measures of early graft injury and function. Survival and clinical outcomes are reported.
RESULTS There were 1291 primary LTs included in the analysis, with 3 primary inhaled agents: isoflurane (62%), desflurane (8%), and sevoflurane (30%). In the first 7 days post-transplant, the peak ALT level was lowest for desflurane (352), followed by sevoflurane (411) and isoflurane (481) (P = .09). All groups had similar ALT and TB by 7 days post-transplant. Graft survival for all 3 groups was statistically similar at 1, 7, and 30 days, with equivalent patient and graft survival at 1 year.
CONCLUSIONS All 3 agents had similar rates of early allograft dysfunction and renal dysfunction. Subgroup analysis of high-risk donor grafts showed no statistical difference. In conclusion, administration of desflurane or sevoflurane may provide some early hepatoprotection against IRI, but longer-term outcomes were equivalent for all agents.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
编辑：符校魁 审校：余晓旭