新型数字化血流限制器在兔肝限流模型中的应用研究  

Applied Reasearch of a Novel Digital Blood Limiter on Rabbit Liver Flow-Limiting Model

作　　者：王羽凝[1] 徐文焕[2] 陈力[3] WANG Yu-ning XU Wen-huan CHEN Li(Clinical division of surgery, Chinese PLA general hospital, Beijing, 100853, China)

机构地区：[1]中国人民解放军总医院外科临床部,北京100853 [2]中国人民解放军总医院医务部 [3]中国人民解放军总医院急诊科

出　　处：《中国急救复苏与灾害医学杂志》2017年第3期233-235,共3页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：国家自然科学基金：青年基金项目（81400648）;北京市科技新星扶持项目（Z15111000030000/XXJH20158100）

摘　　要：目的基于超声多普勒技术，研制一套可精确控制肝切除术中门静脉血流的新兴数字化血流限制器，并建立兔门静脉限流模型，探讨装置在肝脏外科手术中的应用前景。方法分别研制基于超声多普勒技术的监测系统，对门静脉加压的血流定量限制系统、血流量显示系统。将三个子系统合成为新型数字化血流限制器。建立兔门静脉血流限制模型，检测应用此装置后肝灌注压与门静脉血流变化的关系。结果成功研制上述装置，限流器具有大、中、小号三种规格，兔门静脉限流模型中选择门静脉起始段作为限流部位。门静脉完全开放状态下，肝动脉开放与否，对肝脏灌注无显著影响。肝动脉夹闭状态下，随着门静脉血流量减少，肝脏灌注逐渐降低。以门静脉完全开放时肝脏灌注压及门静脉血流量为100％，完全夹闭时肝脏灌注压及门静脉血流量为0％，Pearson分析发现肝脏灌注压与门静脉血流百分比成正相关（r=0．866，P〈0．05）。进行线性回归得到线性回归方程：P（Pu％）=0．296＋0．662V（ml·min-1％）。结论本研究成功研制出新型门静脉血流限制装置并获得国家知识产权局专利认证，新西兰大耳兔门静脉血流限制模型中，门静脉血流同肝脏灌注存在线性相关。新型数字化血流限制器对于精准肝脏外科可能存在重要意义。Objective To manufacture a novel digital blood limiter which was based on Doppler ultrasound and could precisely regulate portal venous flow during hepatectomy, establish a rabbit model of restriction on portal venous flow. Methods Firstly, we separately manufactured the monitoring system based on Doppler ultrasound, the vascular control system by applying pressure to portal vein and the display system showing the amount of blood flow. And with the assembling of all the components above, we obtained the novel digital blood limiter. Then we established a rabbit model of regulating blood inflow in portal vein. The correlation between hepatic perfusion pressure and the amount of portal venous flow was tested. Results We developed three sizes of the appliance including large-size, middle-size and small- size. In our experiment, the beginning segment of portal vein was chosen as the location the appliance was set. When portal vein kept open, there was little change in hepatic perfusion whether hepatic artery was occluded or not. When the hepatic artery was clamped using vascular clip, hepatic perfusion reduced with the decreased amount of blood flow in portal vein. We set the percentage of blood flow with total occlusion of portal vein as 0%, and the opposite 100%. Pearson Correlation analysis revealed that there was a positive correlation between the reduction of hepatic perfusion and the decreased amount of blood flow in portal vein （r=0.866, P 〈0.05） and linear regression equation was P（Pu% ）=0.296＋0.662V （ml. min-1% ）.Conclusions In this research, we successfully manufactured the novel digital blood limiter with national patent certificated In the rabbit model.of restriction on portal venous flow, the linear positive correlation between hepatic perfusion and the amount of blood flow in portal vein was proved. It supposed that the novel digital blood limiter might be important for precise hepatobiliary surgery.

关 键 词：肝脏灌注压 数字化血流限制器 肝切除 

分 类 号：R657.3[医药卫生—外科学]