非静脉转流猪原位肝移植术中管理  

Intra - operative management of swine orthotopic liver transplantation without veno - venous bypass

作　　者：刘蕾[1] 马宁[1] 高伟[1] 史源[1] 韩俊峰[1] 高思楠[1] 丁梅[1] 沈中阳[1] 

机构地区：[1]天津市第一中心医院移植外科天津市器官移植重点实验室,300192

出　　处：《中华实验外科杂志》2015年第10期2414-2416,共3页Chinese Journal of Experimental Surgery

基　　金：国家高技术研究发展计划（863计划）资助项目（2012AA021001）;天津市科技计划项目（12ZCZDSY02600、14RCGFSY00147、14ZCZDSY00019）;天津市卫生行业重点攻关项目（12KGl02）

摘　　要：目的总结非静脉转流猪原位肝移植术中管理的经验。方法选取巴马小型猪40头，随机分为供、受体各20头，给予静脉复合麻醉，实施非静脉转流猪原位肝移植术20头。术中监测肝脏功能生化指标、血气分析、电解质及乳酸。结果40头供、受体手术麻醉中出现插管失败行气管切开术1头，其余39头均一次气管插管成功，20头非转流猪原位肝移植受体全部手术存活，冷保存时间为（168．5±11．5）min，手术时间为（158．2±22．3）min，无肝期时间为（22．8．±1．6）min。无肝期心率显著加快，平均动脉压及中心静脉压迅速下降（P〈0．05），给予快速胶体输注后平均动脉压维持在（54．03±13．29）mmHg（1mmHg=0．133kPa）。受体猪术后第1天因腹腔出血死亡1头，术后第3天因胆漏腹腔感染死亡1头，术后5d存活率为90％。结论猪肝移植术中血流动力学波动大，应尽量缩短无肝期时间，无肝期无血管活性药物的快速胶体液输注可以维持血流动力学的相对平稳。Objective To summarize the intra- operative management experience of swine ortho- topic liver transplantation without veno - venous bypass. Methods 40 Bama mini - pigs were used in this study, which were randomly divided into donor group and recipient group, with 20 pigs for each group. 20 cases of orthotopic liver transplantation without veno - venous bypass were performed under general anesthe- sia. Liver biochemistry, arterial blood gas analysis, electrolyte and lactate were measured. Results One pig underwent tracheotomy after failed tracheal intubation, the other 39 pigs were intubated successfully. All of the 20 recipients survived the operation with liver graft cold ischemia time of （168. 5 ± 11.5 ） min, operation time of （ 158.2 ± 22. 3 ） rain and anhepatic time of （22. 8± 1.6） min. During anhepatic period, heart rate increased significandy while mean arterial pressure （MAP） and central venous pressure de- creased significantly （ P 〈 0. 05 ）, and MAP was maintained at （ 54. 03 ± 13.29） mmHg （ 1 mmHg = 0. 133 kPa） with rapid colloid solution infusion. One recipient pig died on post- operative day （POD） 1 for abdominal bleeding. One died on POD 3 for biliary leak related abdominal infection. Post - operative 5 - day survival rate was 90%. Conclusion There＇ re significantly hemodynamic changes during swine liver transplantation. Anhepatic period should be shortened as much as possible. Rapid colloid solution infusion without administration of vasoactive substances may maintain hemodynamic changes relatively stable.

关 键 词：肝移植 非静脉转流 猪 术中管理 

分 类 号：R657.3[医药卫生—外科学]