关键词: 肝移植, 麻醉维持, 肾功能, 认知功能, 丙泊酚, 七氟醚

Abstract:

Objective To compare the application of sevoflurane or propofol anesthesia maintenance in liver transplantation patients and explore its effects on renal function and postoperative cognition and possible mechanisms. Methods A total of 60 patients aged 18 ~ 60 years old and ASA grade Ⅱ-Ⅲ who were scheduled to undergo orthotopic liver transplantation in our hospital were selected. They were randomly divided into two groups （n = 30） according to the different maintenance schemes： group P （propofol group） and group S （sevoflurane group）. Anesthesia maintenance： group P received continuous target-controlled infusion of propofol combined with remifentanil hydrochloride injection during surgery； group S received sevoflurane inhalation combined with infusion of remifentanil hydrochloride injection during surgery. The mean arterial pressure （MAP）， heart rate （HR） and central venous pressure （CVP） of the two groups of patients were recorded at seven time points， including before anesthesia induction （T0）， immediately after skin incision （T1）， 30 minutes in the anhepatic phase （T2）， 3 hours in the neohepatic phase （T3）， 12 hours after surgery （T4）， 24 hours after surgery （T5） and 72 hours after surgery （T6）. 3 mL of central venous blood was drawn from each group. The serum neutrophil gelatinase-associated lipocalin （NGAL）， serum cystatin C （Cys C）， kidney injury molecule 1 （KIM-1）， syndecan 1 （SDC-1）， heparin sulfate （HS）， hyaluronic acid （HA） and serum concentrations of inflammatory markers （TNF-α， IL-6） were detected by ELISA at the above time points. The cognitive function was evaluated by the Mini-Mental State Examination （MMSE） at T0， T5 and T6， and the occurrence of cognitive dysfunction （MMSE < 23 points） was counted. Results There were no significant differences in MAP， HR， and CVP between the two groups at each time point （P > 0.05）. At T4， the serum levels of NGAL and Cys in the two groups were significantly higher than those in the other groups. C and KIM-1 increased， and the P group was significantly higher than the S group， the difference was statistically significant （P < 0.05）， and there was no significant difference between the two groups at other times （P > 0.05）； SDC-1， HS， and HA increased significantly in both groups at T3 and T4， and the P group was significantly higher than the S group at T4， the difference was statistically significant （P < 0.05）， and there was no significant difference between the two groups at other times （P > 0.05）； TNF-α and IL-6 increased significantly in both groups at T3 and T4， decreased at T5 and T6， but still higher than T0， and the P group was significantly higher than the S group at T4 and T5， the difference was statistically significant （P < 0.05）； MMSE scores decreased at T5 and T6， and the P score was significantly lower than the S group at T5， the difference was statistically significant （P < 0.05）， and there was no significant difference at T6 （P > 0.05）； there was no significant difference in the incidence of postoperative cognitive dysfunction between the two groups （P > 0.05）. Conclusion Compared with propofol， sevoflurane anesthesia maintenance has less effect on the degree of short-term renal injury and cognitive function changes in patients undergoing liver transplantation， which may be related to its more obvious effect of inhibiting inflammatory response and reducing glycocalyx degradation.

Key words: liver transplantation, anesthesia maintenance, renal function, cognitive function, propofol, sevoflurane