丙泊酚与地氟醚麻醉对活体肝移植婴儿术后肝肾功能的影响：一项随机对照试验。

Impact of propofol versus desflurane anesthesia on postoperative hepatic and renal functions in infants with living-related liver transplantation: a randomized controlled trial.

机构信息

Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan Er Road, Yu Zhong District, Chongqing, 400014, P.R. China.

Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.

出版信息

BMC Med. 2024 Sep 16;22(1):397. doi: 10.1186/s12916-024-03622-6.

DOI:10.1186/s12916-024-03622-6

PMID:39285414

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11406785/

Abstract

BACKGROUND

The effects of anesthetics on liver and kidney functions after infantile living-related liver transplantation (LRLT) are unclear. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) or desflurane-based inhalation anesthesia on postoperative liver and kidney functions in infant recipients after LRLT and to evaluate hepatic ischemia-reperfusion injury (HIRI).

METHODS

Seventy-six infants with congenital biliary atresia scheduled for LRLT were randomly divided into two anesthesia maintenance groups: group D with continuous inhalation of desflurane and group P with an infusion of propofol. The primary focus was to assess alterations of liver transaminase and serum creatinine (Scr) levels within the first 7 days after surgery. And the peak aminotransferase level within 72 h post-surgery was used as a surrogate marker for HIRI.

RESULTS

There were no differences in preoperative hepatic and renal functions between the two groups. Upon the intensive care unit (ICU) arrival, the levels of aspartate aminotransferase (AST, P = 0.001) and alanine aminotransferase (ALT, P = 0.005) in group P were significantly lower than those in group D. These changes persisted until the fourth and sixth days after surgery. The peak AST and ALT levels within 72 h after surgery were also lower in group P than in group D (856 (552, 1221) vs. 1468 (732, 1969) U/L, P = 0.001 (95% CI: 161-777) and 517 (428, 704) vs. 730 (541, 1100) U/L, P = 0.006, (95% CI: 58-366), respectively). Patients in group P had lower levels of Scr upon the ICU arrival and on the first day after surgery, compared to group D (17.8 (15.2, 22.0) vs. 23.0 (20.8, 30.8) μmol/L, P < 0.001 (95% CI: 3.0-8.7) and 17.1 (14.9, 21.0) vs. 20.5 (16.5, 25.3) μmol/L, P = 0.02 (95% CI: 0.0-5.0) respectively). Moreover, the incidence of severe acute kidney injury was significantly lower in group P compared to that in group D (15.8% vs. 39.5%, P = 0.038).

CONCLUSIONS

Propofol-based TIVA might improve liver and kidney functions after LRLT in infants and reduce the incidence of serious complications, which may be related to the reduction of HIRI. However, further biomarkers will be necessary to prove these associations.

摘要

背景

麻醉药物对婴幼儿活体肝移植（LRLT）后肝肾功能的影响尚不清楚。本研究旨在探讨异丙酚全凭静脉麻醉（TIVA）或地氟醚吸入麻醉对 LRLT 后婴幼儿受体术后肝肾功能的影响，并评估肝缺血再灌注损伤（HIRI）。

方法

76 例先天性胆道闭锁患儿拟行 LRLT，随机分为两组：D 组持续吸入地氟醚，P 组输注异丙酚。主要观察指标为术后 7 天内肝转氨酶和血清肌酐（Scr）水平的变化。术后 72 小时内转氨酶峰值作为 HIRI 的替代标志物。

结果

两组患儿术前肝肾功能无差异。入住重症监护病房（ICU）时，P 组天门冬氨酸转氨酶（AST，P=0.001）和丙氨酸转氨酶（ALT，P=0.005）水平明显低于 D 组。这些变化一直持续到术后第 4 天和第 6 天。术后 72 小时内，P 组的 AST 和 ALT 峰值也低于 D 组（856（552，1221）比 1468（732，1969）U/L，P=0.001（95%CI：161-777）和 517（428，704）比 730（541，1100）U/L，P=0.006（95%CI：58-366））。与 D 组相比，P 组患者 ICU 到达时和术后第 1 天的 Scr 水平较低（17.8（15.2，22.0）比 23.0（20.8，30.8）μmol/L，P<0.001（95%CI：3.0-8.7）和 17.1（14.9，21.0）比 20.5（16.5，25.3）μmol/L，P=0.02（95%CI：0.0-5.0））。此外，P 组严重急性肾损伤的发生率明显低于 D 组（15.8%比 39.5%，P=0.038）。