Acute liver failure, also known as fulminant hepatic failure (FHF), includes a spectrum of clinical entities characterized by acute liver injury, severe hepatocellular dysfunction and hepatic encephalopathy. The objective of this study was to assess cerebral autoregulation (CA) in 25 patients (19 female) with FHF and to follow up with seventeen of these patients before and after liver transplantation. The mean age was 33.8 years (range 14–56, SD 13.1 years). Cerebral hemodynamics was assessed by transcranial Doppler (TCD) bilateral recordings of cerebral blood velocity (CBv) in the middle cerebral arteries (MCA). CA was assessed based on the static CA index (SCAI), reflecting the effects of a 20–30 mmHg increase in mean arterial blood pressure on CBv induced with norepinephrine infusion. SCAI was estimated at four time points: pretransplant and on the 1st, 2nd and 3rd posttransplant days, showing a significant difference between pre- and posttransplant SCAI ( = 0.005). SCAI peaked on the third posttransplant day ( = 0.006). Categorical analysis of SCAI showed that for most patients, CA was reestablished on the second day posttransplant (SCAI > 0.6). These results suggest that CA impairment pretransplant and on the 1st day posttransplant was re-established at 48–72 h after transplantation. These findings can help to improve the management of this patient group during these specific phases, thereby avoiding neurological complications, such as brain swelling and intracranial hypertension.

中文翻译：

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暴发性肝衰竭的 TCD 评估：肝移植后脑自动调节的改善

急性肝衰竭，也称为暴发性肝衰竭（FHF），包括一系列以急性肝损伤、严重肝细胞功能障碍和肝性脑病为特征的临床实体。本研究的目的是评估 25 名 FHF 患者（19 名女性）的大脑自动调节 (CA)，并对其中 17 名患者在肝移植前后进行随访。平均年龄为 33.8 岁（范围 14-56，SD 13.1 岁）。通过经颅多普勒 (TCD) 双侧记录大脑中动脉 (MCA) 的脑血流速度 (CBv) 来评估脑血流动力学。 CA 根据静态 CA 指数 (SCAI) 进行评估，反映平均动脉血压增加 20-30 mmHg 对去甲肾上腺素输注诱导的 CBv 的影响。 SCAI 在四个时间点进行估计：移植前以及移植后第 1 天、第 2 天和第 3 天，显示移植前和移植后 SCAI 之间存在显着差异 (= 0.005)。 SCAI 在移植后第三天达到峰值 (= 0.006)。 SCAI 的分类分析表明，对于大多数患者来说，CA 在移植后第二天重新建立（SCAI > 0.6）。这些结果表明，移植前和移植后第一天的 CA 损伤在移植后 48-72 小时重新建立。这些发现有助于改善该患者群体在这些特定阶段的管理，从而避免神经系统并发症，例如脑肿胀和颅内高压。