| Objective:To investigate the effect of ulinastatin on the damage of the central nervous system and the encephalic protection mechanism in patients undergoing living-related liver transplantation(LRLT).Methods: Sixty pediatric patients with congenital biliary atresia,of both sexes,aged 6~10months,weighing 6.5~9.5 kg,of American Society of Anesthesiologists physical status or ? ?,child-pugh classification B-C,Donors with an average age of 33,the same blood type,Cut out left lobe for liver transplantation,scheduled for elective LRLT,were randomly divided into either control group(group C,n=30)or ulinastatin group(group U,n=30)using a random number table.Starting from the end of anesthesia induction to the end of surgery,ulinastatin 10000U/kg was infused intravenously in group U,with the equal volume of normal saline was infused intravenously in group C,Before operation,at 30 min of anhepatic phase,and at 3 and 24 h of reperfusion phase,blood samples were down from the central vein for determination of S-100? protein and neuron-specific enzyme in serum by enzyme-linked immunosorbent assay and concentrations of Interleukin-6(IL-6),Interleukin-10(IL-10)and Interleukin-18(IL-18)in serum by radio-immunity method.HR?MAP?CVP and BIS were also recorded at four different points in time.Then assess postoperative delirium 1 day after surgery by PAED(Pediatric Anesthesia Emergence Delirium)and evaluated its mental development index(MDI)and psychomotor development index(PDI)to get the neurocognitive condition at the time of 24 h before operation,and 1 week of postoperative using BSID-(Bayley ?Scale of Infant Development-?).Resluts: Two groups of patients with general information including age,weight,operation length,anesthesia length,anhepatic length and fluid volume were not significant different(P>0.05).Two groups of patients with the serum concentrations of S-100? protein and neuron-specific enzyme were not significant different(P>0.05).Compared with respective T1,Two groups of patients with the serum concentrations of S-100? protein and neuron-specific enzyme were increased at 30 min of anhepatic phase and 3 hours of reperfusion phase(P<0.05).Compared with respective T4,Two groups of patients with the serum concentrations of S-100? protein and neuron-specific enzyme were not significant different(P>0.05).Compared with group C,the serum concentrations of S-100? protein and neuron-specific enzyme were decreased in group U(P<0.05).Two groups of patients with the IL-6,IL-10,IL-18 were not significant different at T1(P>0.05).Compared with group C,IL-6,IL-18 were significant decreased,IL-10 was significant increased in group U(P<0.05).The MDI and PDI in the two groups were reduced 1 week after operation,In group D the MDI reduce lesser than group C(P < 0.05).Conclusion: The brain injury may appear during the perioperation in infants undergoing parent liver transplantation and gradually aggravated during the anhepatic phase and it gradually returns to the preoperative level 24 h postoperativelly.The serum concentrations of S-100? protein and neuron-specificenzyme is positive correlation of the damage of the central nervous system.There can be a predictive indicator of the damage of the central nervous system.Research shows that Two groups of patients with the serum concentrations of S-100? protein and neuron-specific enzyme were increased at 30 min of anhepatic phase and 3 hours of reperfusion phase,It shows that the brain injury appeared during the perioperation in infants undergoing parent liver transplantation.The inflammatory reaction has involved in the process of brain damage,Compared with group C,the serum concentrations of S-100? protein and neuron-specific enzymeIL-6,IL-18 were significant decreased,IL-10 was significant increased in group U,It shows that ulinastatin play a role in brain protection.Ulinastatin 10000U/kg infused intravenously during operation can reduce brain injury in the pediatric patients undergoing LRLT. |
PDF Full Text Request