Clinical Utility of an Automated Pupillometer for Assessing and Monitoring Recipients of Liver Transplantation
Clinical Utility of an Automated Pupillometer for Assessing and Monitoring Recipients of Liver Transplantation
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自动瞳孔计在评估和监测肝移植受者中的临床应用
DOI：
10.1002/lt.21924
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发表时间：
2009-12-01
影响因子：
4.6
通讯作者：
Zheng, Shusen
中科院分区：
文献类型：
--
作者：
Yan, Sheng;Tu, Zhenhua;Zheng, Shusen
瞳孔检查已被作为危重病人的基本检查手段，对疾病的预后和处理具有重要意义。自动瞳孔计是一种以计算机为基础的红外数字视频系统，它显著提高了瞳孔检查的准确性和精确度。我们进行了一项在临床肝移植环境中使用自动瞳孔测量进行瞳孔评估的观察性研究，包括移植前评估和移植后监测。我们的研究结果表明，（4级肝性脑病）潜伏期延长（左侧：283 +/- 80毫秒;右侧：295 +/- 96毫秒）和瞳孔收缩率降低（左直接反应：0.23 +/- 0.10;左间接反应：0.21 +/- 0.07;右直接反应：0.20 +/- 0.08;右间接反应：0.21 +/- 0.08）与正常和清醒患者相比。肝移植术后，这些患者的瞳孔图恢复比清醒患者慢。然而，没有重大并发症的存活受者的瞳孔反应都逐渐恢复，这发生在移植后的第一天或第二天。我们还报告了4例无效的LT，在没有移植前瞳孔反应和其他瞳孔异常所揭示的自动瞳孔测量在我们的研究。总之，4级肝性脑病患者LT后瞳孔反应迟缓，恢复延迟。自动瞳孔计可能是接受LT患者移植前筛查和移植后监测的补充设备，但需要进一步的前瞻性研究。肝移植15：1718-1727，2009。(C)2009年AASLD。
Pupil examination has been used as a basic measure in critically ill patients and has great importance for the prognosis and management of disease. An automated pupillometer is a computer-based infrared digital video system by which the accuracy and precision of the pupil examination are markedly improved. We conducted an observational study of pupil assessment with automated pupillometry in clinical liver transplantation settings, including pretransplant evaluations and posttransplant surveillance. Our results showed that unconscious patients (grade 4 hepatic encephalopathy) had a prolonged latency phase (left side: 283 +/- 80 milliseconds; right side: 295 +/- 96 milliseconds) and a reduced pupillary constrictive ratio (left direct response: 0.23 +/- 0.10; left indirect response: 0.21 +/- 0.07; right direct response: 0.20 +/- 0.08; right indirect response: 0.21 +/- 0.08) in comparison with normal and conscious patients. After liver transplantation, the recovery of pupillography in these patients was slower than that in conscious patients. However, the surviving recipients without major complications all had a gradual recovery of pupillary responses, which occurred on the first or second posttransplant day. We also reported 4 cases of futile LT in the absence of pretransplant pupillary responses and other pupillary abnormalities revealed by automated pupillometry in our study. In conclusion, patients with grade 4 hepatic encephalopathy had a sluggish pupil response and a delayed recovery pattern after LT. An automated pupillometer is potentially a supplementary device for pretransplant screening and posttransplant monitoring in patients undergoing LT, but further prospective studies are required. Liver Transpl 15: 1718-1727, 2009. (C) 2009 AASLD.