低温机械灌注减轻离体猪小肠的微循环损伤  

Hypothermia mechanical perfusion alleviates microcirculation injury in isolated pig small intestine

作　　者：李明阳 马宁[1] 余向洋 史源[2] 刘蕾[2] 谭志军[3] Li Mingyang;Ma Ning;Yu Xiangyang;Shi Yuan;Liu Lei;Tan Zhijun(First Central Clinical College of Tianjin Medical University,Tianjin 300192,China)

机构地区：[1]天津医科大学一中心临床学院,300070 [2]天津市第一中心医院器官移植中心,300070 [3]天津市第一中心医院普外科,300070

出　　处：《中华器官移植杂志》2018年第11期676-680,共5页Chinese Journal of Organ Transplantation

基　　金：国家国际科技合作专项项目(2015DFG31850).

摘　　要：目的探讨低温机械灌注(HMP)保存减轻离体猪小肠微循环损伤的作用。方法选用健康巴马小型猪10只,随机数字表法将猪分为两组。(1)HMP组:5只,将获取的离体小肠及其供应动、静脉血管连接HMP保存装置,于4℃下保存6h;(2)UW液组:5只,将获取的离体小肠及其供应动、静脉血管以4℃乳酸林格液冲洗,并于4℃下用UW液冷保存6h;保存时间到后均行自体原位小肠移植。分别于开腹前(或获取小肠时)与移植肠袢血流开放后30min时检测两组猪血清一氧化氮(NO)和内皮素(ET-1)含量,检测小肠组织的干湿比(小肠组织湿重/干重),采用激光多普勒测速仪检测小肠壁血流流速,以及进行小肠组织病理学检查。结果HMP组与UW液组间,开腹前猪血清ET-1、NO含量的差异均无统计学意义(P>0.05);移植肠袢血流开放30min时猪血清ET-1含量均升高,血清NO含量均降低,且UW液组均更为明显(P<0.05)。小肠离体时,两组小肠组织干湿比的差异无统计学意义(P<0.05);血流开放30min时,UW液组小肠组织干湿比明显低于HMP组(P<0.05)。开腹后两组猪小肠壁微循环血流速度的差异无统计学意义(P>0.05);血流开放30min时,两组血流速度均明显下降,且UW液组下降更为明显(P<0.05)。血流开放30min时,HMP组猪小肠组织可见固有膜轻度水肿,散在淋巴细胞浸润,绒毛表面上皮无脱落,无毛细血管充血;而UW液组猪小肠组织可见固有膜水肿充血,淋巴细胞浸润,绒毛上皮细胞部分脱落,局灶性糜烂,毛细血管充血。结论与UW液冷保存相比,经HMP保存能够减轻猪小肠微血管损伤,并减轻小肠组织由于缺血缺氧所带来的水肿及损伤。Objective To study the effect of hypothermia mechanical perfusion (HMP) preservation on microcirculation injury of isolated pig small intestine.Methods Ten healthy Bama miniature pigs were selected.The experimental animals were randomly divided into two groups.In HMP group (n=5),the intestine of 200 cm in length and corresponding blood vessels were cut and then connected to HMP storage device at 4 ℃ for 6 h.In UW group (n=5),the intestine of 200 cm in length and corresponding blood vessels were cut and then preserve in 4 ℃ UW solution for 6 h.Situ small intestine transplantation was performing when preservation finished.The serum NO and ET-1,the dry-wet ratios of intestine tissue,blood flow velocity of intestinal microcirculation and pathological changes of tissues were detected before and after preservation.Results There was no significant difference in serum ET-1 and NO between HMP group and UW group (P>0.05) before laparotomy.The levels of serum ET-1 increased and serum NO decreased after 30 min of blood flow opening in the transplanted intestine in both groups,more significantly in UW group.There was no significant difference in dry-wet ratio of small intestine before transplantation between the two groups (P>0.05).When the blood flow was opened for 30 min,the dry wet ratio of small intestine in UW group was significantly lower than that in HMP group.There was no significant difference in blood flow velocity of intestinal microcirculation between the two groups before transplantation (P>0.05),and the blood flow velocity of the two groups decreased significantly after 30 min of blood flow opening,more significant in UW group (P<0.05).When the blood flow was opened for 30 min,there was mild edema of the lamina propria in the small intestinal tissue of the HMP group,scattered infiltration of the lymphocytes,no exuviation on the surface of the villi and no capillary congestion;In the small intestinal tissue of the UW group,there were edema and congestion of the intrinsic membrane,infiltration of the lymphocyt

关 键 词：猪 小肠移植 微循环 低温机械灌注 冷保存 

分 类 号：R656.7[医药卫生—外科学]