大鼠肝静脉短暂阻断后肝脏的血流动力学变化与再灌注损伤  

Transient Hepatic Venous Occlusion Induced Liver Hemodynamic Change and Reperfusion Injury in Rats

作　　者：谭晓宇[1,2] 陆树桐[1] 刘军[1] 许文犁[2] 许寅喆 葛新兰[2] 张爱群[2] 李崇辉[2] 董家鸿[2] 

机构地区：[1]广州军区广州总医院肝胆外科,广州510010 [2]中国人民解放军总医院肝胆外科全军肝胆外科研究所,北京100853

出　　处：《中国医学科学院学报》2014年第4期394-399,共6页Acta Academiae Medicinae Sinicae

基　　金：国家自然科学基金(81271738);国家科技支撑计划(2012BAI06B01)~~

摘　　要：目的观察短暂出肝血流阻断与短暂入肝血流阻断对大鼠肝叶的血流动力学和再灌注损伤的影响。方法在同一大鼠肝脏的不同肝叶建立3个不同的区域:(1)非孤立型肝叶淤血再灌注(NIL-CR)区:分离大鼠肝右中叶肝静脉,并予无损伤血管夹夹闭肝静脉30 min后开放;(2)孤立型肝叶淤血再灌注(IL-CR)区:分离大鼠左肝叶肝静脉,并予无损伤血管夹夹闭肝静脉30 min后开放;(3)缺血再灌注(IR)区:予无损伤血管夹阻断大鼠肝右上叶入肝血流30 min后开放,于血流阻断后30 min、复流后1、3、7 d等4个时相点分别检测大鼠肝脏各区域的末梢微循环血流量、氧饱和度以及肝组织切片的Suzuki评分。结果血流阻断后30 min,IR区的微循环流量显著高于NIL-CR区、IL-CR区(P均<0.01),IR区的氧饱和度显著高于NIL-CR区(P<0.01)、IL-CR区(P<0.05);在肝组织切片的Suzuki评分中,NIL-CR区和IL-CR区在血流阻断后30 min、复流后1 d的分值均显著高于IR区(P均<0.01)。但NIL-CR区与IL-CR区在末梢微循环血流量、氧饱和度以及Suzuki评分上差异均无统计学意义(P>0.05)。结论肝静脉阻断能更显著地降低肝组织末梢循环的血流灌注和氧饱和度,导致CR比IR产生更显著的肝损伤效应。淤血区周边是否有正常肝组织接壤的因素并不对CR的损伤程度产生影响。Objective To observe the hemodynamic change and reperfusion injury cause by transient hepatic venous occlusion and transient hepatic inflow occlusion in rats.Methods The rat liver was divided into 3 different areas：the ischemia reperfusion （IR） area：the inflow of the right superior lobe was clamped for half an hour; the non-isolated lobe congestive reperfusion （NIL-CR） area：the outflow of the right median lobe was clamped for half an hour; and the isolated lobe congestive reperfusion （IL-CR） area：the outflow of the left lobe was clamped for half an hour.The flux value and the oxygen saturation of microcirculation were monitored before at clamping for 30 minutes,and on 1 day,3 days,and 7 days after reperfusion.The hepatic damage and Suzuki＇ s score were evaluated.Results After clamping for 30 minutes,the flux value in the IR area was significantly higher than in NIL-CR area （P ＜0.01） and IL-CR area （P ＜0.01）,the oxygen saturation in the IR area was significantly higher than in NIL-CR area （P ＜0.01） and IL-CR area （P ＜0.05）.Compared with IR area,both NIL-CR area and IL-CR area were found having more severe liver damage in terms of Suzuki＇ s score in early postoperative period （at clamping for 30 minutes and on 1 day,P ＜0.01）.However,there was no significant difference between NIL-CR area and IL-CR area in flux value,oxygen saturation,and Suzuki＇ s score （P ＞ 0.05）.Conclusions Hepatic venous occlusion can more effectively decrease the blood perfrusion and oxygen saturation ; thus,compared to the IR,CR can result in more severe liver damage.The presence of normal liver tissue around the congestion area can not influence liver damage in transient hepatic venous occlusion.

关 键 词：肝静脉 微循环 血流动力学 再灌注损伤 

分 类 号：R331.3[医药卫生—人体生理学]