肝移植和对大脑自我调节的影响:一个系统的范围审查
Tommaso Rochat1, Artida Ulaj1, Frederic Sangla1
1University Hospitals of Geneva, Geneva, Switzerland.
Frontiers in transplantation
|February 4, 2026
概括
在肝移植期间对大脑自身调节 (CA) 的监测是不一致的,特别是在急性肝衰竭中. 需要更多的标准化研究来了解它对大脑血液流动和患者结果的影响.
科学领域:
- 神经学 神经学
- 移植医学 移植医学
- 关键的护理关键的护理
背景情况:
- 大脑自调节 (CA),大脑保持稳定的脑血流 (CBF) 尽管平均动脉压 (MAP) 变化的大脑的能力,可能会在正管肝移植 (OLT) 期间被破坏.
- 在OLT期间发生的深度代谢,炎症和血液动力学变化可能会损害CA,危及大脑低或高血压.
- 在OLT期间受损CA的术后演变和临床意义尚不清楚.
研究的目的:
- 系统地审查和综合现有关于在OLT期间大脑自我调节监测的证据.
- 确定在OLT患者中CA监测的方法限制和潜在的临床应用.
主要方法:
- 一个系统的范围审查,遵循乔安娜·布里格斯研究所 (JBI) 的指南.
- 搜索了PubMed,Embase,Scopus,Web of Science和Medline的研究,以评估成年OLT患者的外科手术期CA.
- 包括六项研究 (n=99) 量化评估CA.
主要成果:
- 使用多种方法 (TCD,NIRS,PRx,Mx,COx,SCAI,TFA) 来评估CA,监测阶段和损伤定义存在显著差异.
- 在急性肝衰竭中,CA通常在移植前受损,并在术后得到改善,但在慢性肝病中发现的结果不一致.
- 很少有研究探讨了CA与神经系统结果的关联,结果不确定的结果.
结论:
- 大脑自调节在OLT期间发生动态变化,特别是在急性肝衰竭中,但目前的证据受到异质性和小样本大小的限制.
- 需要标准化,前性研究来澄清CA监测的作用.
- 进一步的研究应该调查以CA监测为指导的个性化血压管理是否可以改善神经结果.
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