PDF(Pubmed)
Abstract：
BACKGROUND: Cerebrovascular autoregulation in patients with acute and chronic liver failure is often impaired, yet an intact autoregulation is essential for the demand-driven supply of oxygenated blood to the brain. It is unclear, whether there is a connection between cerebrovascular autoregulation during liver transplantation (LTX) and the underlying disease, and if perioperative anesthesiologic consequences can result from this.
METHODS: In this prospective observational pilot study, data of twenty patients (35% female) undergoing LTX were analyzed. Cerebral blood velocity was measured using transcranial doppler sonography and was correlated with arterial blood pressure. The integrity of dynamic cerebrovascular autoregulation (dCA) was evaluated in the frequency domain through transfer function analysis (TFA). Standard clinical parameters were recorded. Mixed one-way ANOVA and generalized estimating equations were fitted to data involving repeated measurements on the same patient. For all other correlation analyses, Spearman\'s rank correlation coefficient (Spearman\'s-Rho) was used.
RESULTS: Indications of impaired dCA are seen in frequency domain during different phases of LTX. No correlation was found between various parameter of dCA and primary disease, delirium, laboratory values, length of ICU or hospital stay, mortality or surgical technique.
CONCLUSIONS: Although in most cases the dCA has been impaired during LTX, the heterogeneity of the underlying diseases seems to be too diverse to draw valid conclusions from this observational pilot study.
METHODS: In this prospective observational pilot study, data of twenty patients (35% female) undergoing LTX were analyzed. Cerebral blood velocity was measured using transcranial doppler sonography and was correlated with arterial blood pressure. The integrity of dynamic cerebrovascular autoregulation (dCA) was evaluated in the frequency domain through transfer function analysis (TFA). Standard clinical parameters were recorded. Mixed one-way ANOVA and generalized estimating equations were fitted to data involving repeated measurements on the same patient. For all other correlation analyses, Spearman\'s rank correlation coefficient (Spearman\'s-Rho) was used.
RESULTS: Indications of impaired dCA are seen in frequency domain during different phases of LTX. No correlation was found between various parameter of dCA and primary disease, delirium, laboratory values, length of ICU or hospital stay, mortality or surgical technique.
CONCLUSIONS: Although in most cases the dCA has been impaired during LTX, the heterogeneity of the underlying diseases seems to be too diverse to draw valid conclusions from this observational pilot study.
摘要：
背景：急性和慢性肝衰竭患者的脑血管自动调节常常受损，然而，完整的自动调节对于需求驱动的向大脑供应含氧血液至关重要。不清楚,肝移植（LTX）过程中的脑血管自动调节与基础疾病之间是否存在联系，如果围手术期的麻醉后果可以由此产生。
方法：在这项前瞻性观察性试点研究中，分析了20例接受LTX的患者（35％为女性）的数据。使用经颅多普勒超声检查测量脑血流速度，并与动脉血压相关。通过传递函数分析（TFA）在频域中评估了动态脑血管自动调节（dCA）的完整性。记录标准临床参数。将混合的单向ANOVA和广义估计方程拟合到涉及对同一患者的重复测量的数据。对于所有其他相关分析，使用Spearman等级相关系数(Spearman's-Rho)。
结果：在LTX的不同阶段，在频域中可以看到dCA受损的迹象。dCA的各种参数与原发病无相关性,谵妄,实验室值，ICU或住院时间，死亡率或手术技术。
结论：尽管在大多数情况下，LTX期间dCA受损，基础疾病的异质性似乎太多样,无法从这项观察性试验研究中得出有效的结论.
方法：在这项前瞻性观察性试点研究中，分析了20例接受LTX的患者（35％为女性）的数据。使用经颅多普勒超声检查测量脑血流速度，并与动脉血压相关。通过传递函数分析（TFA）在频域中评估了动态脑血管自动调节（dCA）的完整性。记录标准临床参数。将混合的单向ANOVA和广义估计方程拟合到涉及对同一患者的重复测量的数据。对于所有其他相关分析，使用Spearman等级相关系数(Spearman's-Rho)。
结果：在LTX的不同阶段，在频域中可以看到dCA受损的迹象。dCA的各种参数与原发病无相关性,谵妄,实验室值，ICU或住院时间，死亡率或手术技术。
结论：尽管在大多数情况下，LTX期间dCA受损，基础疾病的异质性似乎太多样,无法从这项观察性试验研究中得出有效的结论.
