无静脉转流大动物劈离式原位肝移植模型的建立  

The establishment of split-orthotopic liver transplantation without veno-venous bypasss in large animals model

作　　者：付建峰[1] 高伟[2] 刘蕾[2] 陈静[2] 沈中阳[2] 

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第一中心医院器官移植中心,天津300192

出　　处：《实用器官移植电子杂志》2016年第2期70-74,共5页Practical Journal of Organ Transplantation(Electronic Version)

基　　金：国家高技术研究发展计划(863计划)(2012AA021001);国家国际科技合作专项项目(2015DFG31850);天津市科技计划项目(12ZCZDSY02600)

摘　　要：目的总结无静脉转流条件下猪劈离式原位肝移植模型建立的经验。方法选取40只巴马小型猪,随机分为供受体各20只,通过建立无静脉转流条件下猪劈离式原位肝移植模型,观察术中血流动力学及血气分析变化,探讨围手术期相关处理对模型建立的影响。结果 20只无静脉转流条件下猪劈离式原位肝移植受体中,18只巴马小型猪于术后1~2小时顺利脱机拔管并于当天麻醉清醒,术后第2天正常进食水,3只受体猪术后第3天因腹腔感染死亡,术后5天存活率为65%。与无肝期前相比,无肝期受体猪的平均动脉压、中心静脉压明显降低,心率明显增快〔平均动脉压(mm Hg):58.5±8.2比105.3±10.0,中心静脉压(cm H_2O):2.17±2.11比5.51±4.06,心率(次/分):151.3±16.0比121.9±8.8,均P<0.05〕。与无肝期相比,新肝期时p H值显著下降,K^+浓度和乳酸浓度显著升高〔p H:7.307±0.083比7.514±0.071,K^+浓度(mmol/L):5.86±0.71比3.36±0.28,乳酸浓度(mmol/L):6.53±1.54比3.39±1.03,均P<0.05〕结论猪劈离式原位肝移植术中血流动力学和血气分析结果波动大,应通过无肝期快速补液、适量给予血管活性药物以维持血流动力学稳定,并尽量缩短无肝期时间,有助于劈离式肝移植手术的成功。Objective To summarize the experience of split-orthotopic liver transplantation model in swines without veno-venous bypass. Methods A total number of 40 Bama mini-swines were used in this study, which were randomly divided into donor group and recipient group, with 20 swines in each group. 20 cases of split-orthotopic liver transplantation without veno-venous bypass were performed under general anesthesia. Arterial blood gas analysis and hemodynamic parameters were measured. The influence of the management during operations was also discussed. Results Eighteen of the recipients were successfully extubated and awake 1-2 hours postoperations. All swines can eat and drink normally on the second post-operative day. Three of them died on the third post-operative day because of abdominal infection. The survival rate of 5 days past operation was 65%. Compared with pre-anhepatic phase, the mean arterial pressure and central venous pressure were significantly decreased and the heart rate was significantly increase in anhepatic phase〔mean arterial pressure（mm Hg）：58.5±8.2 vs. 105.3±10.0,central venous pressure（cm H2O）：2.17±2.11 vs. 5.51±4.06,heart rate（times/min）：151.3±16.0 vs. 121.9±8.8,allP〈0.05〕. Compared with anhepatic phase, p H value was significantly decreased, K＋ and the concentration of lactic acid were significantly increased in hepato-repepusion〔p H ：7.307±0.083 vs. 7.514±0.071,K＋ concentration（mmol/L）：5.86±0.71 vs. 3.36±0.28,lactic acid（mmol/L）：6.53±1.54 vs. 3.39±1.03,allP〈0.05〕.Conclusion Hemodynamic and arterial blood gas analysis changes significantly during split-orthotopic liver transplantation in swines. By using moderate vasoactive substances, to maintain the hemodynamic parameters stability in the anhepatic phase and the short anhepatic phase are important to perform successful split-orthotopic liver transplantation.

关 键 词：巴马小型猪 劈离 肝移植 模型 

分 类 号：R657.3[医药卫生—外科学]