Ali Yasser, Negmi H, Elmasry N, Sadek M, Riaz A, Al Ouffi H, Khalaf H
Anesthesia Department, King Faisal Specialist Hospital & Research Centre Anesthesia Department MBC22, Riyadh 11211, KSA.
Middle East J Anaesthesiol. 2007 Oct;19(3):513-25.
Heme-Oxygenase-1 catalyzes hemoglobin into bilirubin, iron, and carbon monoxide, a well known vasodilator. Heme-Oxygenase-1 expression and carbon monoxide production as measured by blood carboxyhemoglobin levels, increase in end stage liver disease patients. We hypothesized that there may be a correlation between carboxyhemoglobin level and early graft function in patients undergoing liver transplant surgeries.
In a descriptive retrospective study, 39 patients who underwent liver transplantation between the year 2005 and 2006 at KFSH&RC, are included in the study. All patients received general anesthesia with isoflurane in 50% oxygen and air. Levels of oxyhemoglobin, carboxyhemoglobin and methemoglobin concentration in percentage were recorded at preoperative time, anhepatic phase, end of surgery, ICU admission and 24 hr after surgery. The level of lactic acid, prothrombin time (PT), partial thrombin time (PTT), serum total bilirubin and ammonia were also recorded at ICU admission and 24 hr after surgery. The numbers of blood units transfused were recorded.
39 patients were included in the study with 13/39 for living donor liver transplant (LDLT) compared to 26/39 patients scheduled for deceased donor liver transplant (DDLT). The mean age was 35.9 +/- 16.9 years while the mean body weight was 60.3 +/- 20.9 Kg. Female to male ratio was 21/18. The median packed red blood cell (PRBC) units was 4 (Rang 0-40). There was a significant increase in carboxyhemoglobin level during the anhepatic phase, end of surgery and on ICU admission compared with preoperative value (p<0.005). However, there was insignificant changes in methemoglobin level and significant decrease in oxyhemoglobin levels throughout the study period compared to the preoperative value (p<0.005). The changes in carboxyhemoglobin level on ICU admission and 24 hrs postoperatively were positively correlated with the changes in serum total bilirubin and prothrombin time (R = 0.35, 0.382, 0.325 and 0.31) respectively p<0.05) but not with the changes in serum lactic acid. The same strong correlation was found when analysing LDLT and DDLT patients separately between carboxyhemoglobin concentration and PT and total bilirubin while still the correlation with lactic acid was weak. There was no correlation between average perioperative carboxyhemoglobin concentration during different timing of measurements and average units of transfused blood (R = -0.02) p>0.05.
The changes in carboxyhemoglobin level significantly correlate with the Changes in graft functions particularly prothrombin time and serum total bilirubin and may be used as an early, rapid and simple test for early evaluation of graft function.
血红素加氧酶-1可将血红蛋白催化生成胆红素、铁和一氧化碳（一种众所周知的血管舒张剂）。在终末期肝病患者中，血红素加氧酶-1的表达以及通过血液中碳氧血红蛋白水平测定的一氧化碳生成量会增加。我们推测，在接受肝移植手术的患者中，碳氧血红蛋白水平与早期移植物功能之间可能存在相关性。
在一项描述性回顾性研究中，纳入了2005年至2006年期间在沙特国王法赫德医疗研究中心接受肝移植手术的39例患者。所有患者均接受异氟烷与50%氧气和空气混合的全身麻醉。记录术前、无肝期、手术结束时、入住重症监护病房（ICU）时以及术后24小时氧合血红蛋白、碳氧血红蛋白和高铁血红蛋白浓度的百分比水平。在入住ICU时和术后24小时还记录了乳酸水平、凝血酶原时间（PT）、部分凝血活酶时间（PTT）、血清总胆红素和氨水平。记录输注的血液单位数量。
39例患者纳入研究，其中13/39为活体供肝肝移植（LDLT），26/39为尸体供肝肝移植（DDLT）。平均年龄为35.9±16.9岁，平均体重为60.3±20.9千克。男女比例为21/18。红细胞压积（PRBC）单位中位数为4（范围0 - 40）。与术前值相比，无肝期、手术结束时和入住ICU时碳氧血红蛋白水平显著升高（p<0.005）。然而，与术前值相比，在整个研究期间高铁血红蛋白水平变化不显著，氧合血红蛋白水平显著下降（p<0.005）。入住ICU时和术后24小时碳氧血红蛋白水平的变化分别与血清总胆红素和凝血酶原时间的变化呈正相关（R = 0.35、0.382、0.325和0.31，p<0.05），但与血清乳酸的变化无关。分别分析LDLT和DDLT患者时，碳氧血红蛋白浓度与PT和总胆红素之间也存在同样强的相关性，而与乳酸的相关性仍然较弱。不同测量时间点围手术期平均碳氧血红蛋白浓度与平均输注血液单位数之间无相关性（R = -0.02，p>0.05）。
碳氧血红蛋白水平的变化与移植物功能的变化显著相关，尤其是凝血酶原时间和血清总胆红素，可作为早期评估移植物功能的一种早期、快速且简单的检测方法。
