新型逆灌注法对经典原位肝移植术中内环境及血流动力学的影响  

The effect of a new type of retrograde reperfusion on the intraoperative internal environment and hemodynamics during classic orthotopic liver transplantation

作　　者：杨崇威 黄磊[1] 李新宇[1] 朱继业[1] 冷希圣[1] 

机构地区：[1]北京大学人民医院肝胆外科,100044

出　　处：《中华普通外科杂志》2017年第8期694-697,共4页Chinese Journal of General Surgery

基　　金：北京大学人民医院研究与发展基金资助项目（RDC2015-13）

摘　　要：目的探讨新型逆灌注法对经典原位肝移植患者术中内环境及血流动力学的影响。方法20例经典原位肝移植患者采用新型下腔静脉逆灌注法，供肝门静脉放血前采集上腔静脉血5ml（PsvC）、下腔静脉血5ml（PIVC）及受体门静脉血5ml（PPV），供肝门静脉放血5ml（T1）、100ml（T，）、200ml（T2）时分别采血5ml。比较不同血标本的血气和电解质指标差异及发生再灌注综合征的例数。结果（1）20例患者手术过程顺利，其中4例发生再灌注综合征，发生率为20％。（2）PSVC、PPV、PIVC血气电解质指标比较，pH值、Lac、K^＋、HCO3^-、BEecf等指标差异无统计学意义（P〉0．05）。（3）与PIVC比较，T1、T2、T3时刻pH值、PrO2、SvO2、BEecf、HCO3^-、Lac、K^＋、Ca^2＋等指标都有明显变化（P〈0．05），且均呈恢复趋势，但在T3时刻仍不能恢复PIVC水平（P〈0．05）。结论经典原位肝移植术供肝恢复血流后内环境紊乱的最主要因素来源于供肝内的回心血液；新型逆灌注法能及时排放供肝内部分有害的代谢产物，减小血流动力学剧烈波动。Objective To investigate the effect of a new type of retrograde reperfusion on the intraoperative internal environment and hemodynamics during classic orthotopie liver transplantation （OLT）. Methods 20 patients underwent classic OLT using a new type of retrograde reperfusion in our center. Blood sampling was done at different parts or time points including： before blood venting via the portal vein （PV） of the donor liver, 5 ml of blood was collected from the superior vena cava （ PSVC ） , inferior vena cava （ PIVC） and portal vein （ PPV ）. During retrograde repeffusion through the inferior vena cava （IVC） , 5 mL of blood was collected when the volume of blood venting reached 5 ml （T1 ）, 100 ml （T2 ）, and 200 ml （T3 ）, respectively. The differences of data were compared after the blood samples were analyzed. In addition, the number instances of postreperfusion syndrome （PRS） were recorded. Results All operations were completed successfully, in which PRS occurred in 4 patients （20%）. The most notable findings are the significant changes of nearly all data at T1, T2 and T3, including pH value, PvO2, SvO2, BEecf, HCO3^- , Lac, K^＋ , and Ca^2 ＋ , compared with PIVC （ P 〈 0. 05） and a trend toward recovery in all the data. Yet their levels at T3 did not come back to the levels at PIVC （ P 〈 0. 05 ）. Besides, for pH value, Lac, K ^＋ , HCO3^- and BEecf, there were no significant differences between PSVC, PIVC and PPV （ P 〉 0.05 ） . Conclusions During classic OLT, the main factors leading to a disordered internal environment after recirculation stem from venous return within the donor liver. This new type of retrograde perfusion can eliminate some of the harmful metabolites inside the donor liver in time and to some extent reduce internal environment disorders as well as drastic hemodynamic fluctuations after recirculation.

关 键 词：肝移植 再灌注损伤 血流动力学 

分 类 号：R657.3[医药卫生—外科学]