体外膜肺氧合对心死亡猪的肝脏和胆道的保护和修复作用  

Repair and protective effect of extracorporeal membrane oxygenation on liver and bile duct after cardiac death of pigs

作　　者：隋明昊[1] 刘蕾[2] 史源[2] 马宁[2] 沈中阳[2] 

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

出　　处：《中华肝胆外科杂志》2016年第8期552-556,共5页Chinese Journal of Hepatobiliary Surgery

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

摘　　要：目的探讨体外膜肺氧合（ECMO）对心死亡猪的肝脏和胆道的修复、保护作用。方法巴马小型猪8头，以静脉推注氯化钾的方法诱导心脏停搏，给予标准心肺复苏30min后宣布死亡。经下腔静脉及腹主动脉插管，连接ECMO进行自体血循环4h。实验过程中持续监测肝动脉血流量。记录每小时胆汁生成量并收集胆汁，检测胆汁中乳酸脱氢酶（LDH）、直接胆红素（TBil）和γ-谷氨酰转肽酶（γ-GT）含量。采血检测转氨酶、肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、内皮素-1（ET-1）、透明质酸（HA）和一氧化氮（NO）含量。肝脏和胆道组织切片行HE染色做病理学检查。采用末端脱氧核苷酸转移酶介导的d-UTP缺口末端标记技术（TUNEL）检测胆道细胞凋亡情况。结果实验猪心脏停搏后无胆汁分泌。ECMO运行后4h胆汁分泌量恢复到基础值的80％。胆汁中γ-GT含量为（23．3±11．8）IU／L，LDH为（15．9±3．3）IU／L，DBil为（72．3±21．4）mmol／L，与基础水平相比均无统计学差异（P〉0．05）。血清IL-1含量为（117．6±39．0）ng／L，TNF-α为（120．4±16．5）ng／L，HA为（63．7±4．4）ng／L，与基础水平相比均无统计学差异（P〉0．05）。ET-1含量为（4，9±1．3）ng／L，NO为（135．3±16．7）mmol／L，与基础水平相比有显著差异（P〈0．05）。TUNEL结果显示，ECMO运行4h后胆道凋亡指数比宣布死亡时明显下降（P〈0．05）。病理结果显示，ECMO修复4h后肝细胞和胆管上皮细胞损伤较宣布死亡时明显减轻。结论ECMO对心死亡猪的肝脏和胆道具有一定的保护和修穷作用．Objective To investigate the repair and protective effect of extracorporeal membrane ox- ygenation （ECMO） on liver and bile duct after cardiac death in pig. Methods Eight pigs were purchased and cardiac arrest was induced by the administration of 1 g KCL intravenously, followed by 30 min cardiopulmonary resuscitation according to standard guideline. Cannulas were placed through inferior vena cava and abdominal aorta, and then connected to ECMO extracorporeal circulation pipes. ECMO was performed for 4 h. Circulation flow rate of hepatic artery and bile production were monitored and recorded. Lactate dehydrogenase （LDH）, γ-glutamyl transferase （γ-GT） and direct bilirubin （DBIL） in bile were detected. Transaminase, tumor necrosis factor-α （TNF-α） , interleukin-1 β （ IL-1 β ）, hyaluronic acid （HA） , endothelin-1 （ET-1） and nitric oxide （NO） in serum were detected. Pathological change was observed by HE staining under optical microscope and cell apoptosis was detected by TUNEL. Results There was no bile production after cardiac death, which increased to 80% of the baseline after 4h of ECMO. In addition, 2;- GT, LDH and DBIL content in bile was （23.3 ± 11.8） IU/L, （ 15.9 ± 3.3 ） IU/L and （72. 3 ± 21.4） mmol/ L, and IL-1, TNF-α and HA content in serum was （117.6 ± 39.0）ng/L, （120. 4 ± 16. 5）ng/L and （63.7 ± 4.4） ng/L, respectively, and no statistically significant differences were observed when compared with the baseline （ all P 〉 0.05 ）. ET-1 content was （4. 9 ± 1.3 ） ng/L and NO content was （ 135.3 ± 16.7） mmol/L in serum, which was statistically increased （both P 〈 0.05 ）. Pathological changes of liver and bile duct were significantly alleviated. Conclusion ECMO could exert protective effect on liver and bile duct after cardiac death.

关 键 词：体外膜肺氧合 心死亡器官捐献 肝脏 猪 实验动物 

分 类 号：R-332[医药卫生]