Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Clin Transplant. 2010 Jan-Feb;24(1):91-7. doi: 10.1111/j.1399-0012.2009.01148.x. Epub 2009 Nov 19.
Rapid deterioration of consciousness is a critical situation for patients with fulminant hepatic failure (FHF). Bispectral (BIS) index was derived from electroencephalography parameters, primarily to monitor the depth of unconsciousness.
To assess the usability of peritransplant BIS monitoring in patients with FHF.
A prospective study using peritransplant BIS monitoring was performed in 26 patients with FHF undergoing urgent liver transplantation (LT).
Pre-transplant Child-Pugh score was 12.2 +/- 1.0; model for end-stage liver disease score was 32.4 +/- 4.4; Glasgow coma score (GCS) was 9.9 +/- 1.3; and BIS index was 44.0 +/- 6.7. Pre-transplant sedation significantly decreased BIS index. After LT, all patients having endotracheal intubation recovered consciousness within one to three d and showed progressive increase in BIS index, which appeared slightly earlier and was more evident than the increase in derived GCS score. There was a significant correlation between BIS index and derived GCS scores (r(2) = 0.648). Timing of eye opening to voice was matched with BIS index of 66.3 +/- 10.4 and occurred 12.7 +/- 8.3 h after passing BIS index of 50.
These results suggest that BIS monitoring is a non-invasive, simple, easy-to-interpret method, which is useful in assessing peritransplant state of consciousness. BIS monitoring may therefore be a useful tool during peritransplant intensive care for patients with FHF showing hepatic encephalopathy.
暴发性肝衰竭(FHF)患者意识迅速恶化是一种危急情况。双频谱指数(BIS)源自脑电图参数,主要用于监测无意识深度。
评估 FHF 患者移植前 BIS 监测的可用性。
对 26 例接受紧急肝移植(LT)的 FHF 患者进行了前瞻性研究,使用移植前 BIS 监测。
移植前 Child-Pugh 评分 12.2±1.0;终末期肝病模型评分 32.4±4.4;格拉斯哥昏迷评分(GCS)为 9.9±1.3;BIS 指数为 44.0±6.7。移植前镇静显著降低了 BIS 指数。LT 后,所有气管插管的患者在 1 至 3 天内恢复意识,并表现出 BIS 指数逐渐增加,这比衍生的 GCS 评分增加稍早且更为明显。BIS 指数与衍生的 GCS 评分之间存在显著相关性(r²=0.648)。睁眼至声音的时间与 BIS 指数 66.3±10.4 相匹配,发生在 BIS 指数超过 50 后的 12.7±8.3 小时。
这些结果表明,BIS 监测是一种非侵入性、简单、易于解释的方法,可用于评估移植前的意识状态。因此,BIS 监测可能是 FHF 患者肝性脑病移植前重症监护的有用工具。