Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil; Department of Neurology, Federal University of Pará Medical School, Brazil.
Laboratory for Neurosonology and Cerebral Hemodynamics, Division of Neurological Surgery, Hospital das Clinicas, Sao Paulo University Medical School, Brazil.
Ann Hepatol. 2024 Mar-Apr;29(2):101167. doi: 10.1016/j.aohep.2023.101167. Epub 2023 Oct 4.
Acute liver failure, also known as fulminant hepatic failure (FHF), includes a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction and hepatic encephalopathy. The objective of this study was to assess cerebral autoregulation (CA) in 25 patients (19 female) with FHF and to follow up with seventeen of these patients before and after liver transplantation.
The mean age was 33.8 years (range 14-56, SD 13.1 years). Cerebral hemodynamics was assessed by transcranial Doppler (TCD) bilateral recordings of cerebral blood velocity (CBv) in the middle cerebral arteries (MCA).
CA was assessed based on the static CA index (SCAI), reflecting the effects of a 20-30 mmHg increase in mean arterial blood pressure on CBv induced with norepinephrine infusion. SCAI was estimated at four time points: pretransplant and on the 1st, 2nd and 3rd posttransplant days, showing a significant difference between pre- and posttransplant SCAI (p = 0.005). SCAI peaked on the third posttransplant day (p = 0.006). Categorical analysis of SCAI showed that for most patients, CA was reestablished on the second day posttransplant (SCAI > 0.6).
These results suggest that CA impairment pretransplant and on the 1st day posttransplant was re-established at 48-72 h after transplantation. These findings can help to improve the management of this patient group during these specific phases, thereby avoiding neurological complications, such as brain swelling and intracranial hypertension.
急性肝衰竭，又称暴发性肝衰竭（FHF），包括一系列以急性肝损伤、严重肝细胞功能障碍和肝性脑病为特征的临床实体。本研究的目的是评估 25 例 FHF 患者的脑自动调节（CA），并对其中 17 例患者进行肝移植前后的随访。
平均年龄为 33.8 岁（范围 14-56，SD 13.1 岁）。通过经颅多普勒（TCD）双侧记录大脑中动脉（MCA）的脑血流速度（CBV）来评估脑血流动力学。
根据静态 CA 指数（SCAI）评估 CA，该指数反映了去甲肾上腺素输注引起的平均动脉血压升高 20-30mmHg 对 CBV 的影响。在四个时间点评估 SCAI：移植前和移植后第 1、2、3 天，移植前和移植后 SCAI 之间存在显著差异（p=0.005）。SCAI 在移植后第 3 天达到峰值（p=0.006）。SCAI 的分类分析显示，对于大多数患者，CA 在移植后第 2 天得到重建（SCAI＞0.6）。
这些结果表明，移植前和移植后第 1 天的 CA 损伤在移植后 48-72 小时得到重建。这些发现有助于改善这群患者在这些特定阶段的管理，从而避免神经并发症，如脑水肿和颅内压升高。
