离体肝脏常温机械灌注设备对红细胞影响的实验研究  

Study on Effect of the Normothermic Machine Perfusion Equipment on Erythrocyte in Extracorporeal Liver

作　　者：何锡然 黄小桃 谭晓宇 张琳 刘华敏 邝伟键 梁铭炬 周伟津 郭家钘 陈素平 霍枫 HE Xiran;HUANG Xiaotao;TAN Xiaoyu;ZHANG Lin;LIU Huamin;KUANG Weijian;LIANG Mingju;ZHOU Weijin;GUO Jiaxing;CHEN Suping;HUO Feng(Guangdong Shunde Industry Design Institute(Guangdong Shunde Innovative Design Institute),Foshan Guangdong 528311,China;Department of Hepatobiliary Surgery,General Hospital of Southern Theater Command,Guangzhou Guangdong 510010,China;Guangdong Devocean Medical Instrument Co.,Ltd,Foshan Guangdong 528311,China)

机构地区：[1]广东顺德工业设计研究院(广东顺德创新设计研究院),广东佛山528311 [2]中国人民解放军南部战区总医院肝胆外科,广东广州510010 [3]广东丁沃生医疗器械有限公司,广东佛山528311

出　　处：《中国医疗设备》2020年第12期46-50,共5页China Medical Devices

基　　金：国家青年科学基金项目(81800556);军队实验动物专项科研项目[SYDW(2017)12];佛山顺德区重大科技计划项目(顺府办函[2019]42号)。

摘　　要：目的构建离体肝脏常温机械灌注设备,探讨灌注实验过程对红细胞的影响。方法获取健康雌性巴马小型猪肝脏和血液,利用常温机械灌注设备对离体肝脏持续灌注8 h,温度设定37℃,动脉压力设定80/60 mmHg,门静脉设定恒流模式(0.5 mL/min•g),记录灌注过程中灌注液温度、肝动脉和门静脉流量等数据,每小时化验红细胞及其他相关指标,包括红细胞压积(Hematocrit,HCT)、血红蛋白(Hemoglobin,HGB)、总胆红素(Total Bilirubin,TBIL)、间接胆红素(Indirect Bilirubin,IBIL)、溶血率、乳酸(Lactate,Lac)以及血糖(Glucose,Glu)。结果灌注过程中灌注液温度稳定维持37℃,肝动脉流量从最初的(54.64±11.94)mL/min,上升到(249.34±93.01)mL/min,门静脉流量平均值稳定在(442.67±79.19)mL/min。灌注开始和结束时HCT和HGB分别为(27.67±2.42)%、(9.40±0.81)g/dL和(28.00±2.45)%、(9.52±0.81)g/dL。分别比较灌注开始和结束时HCT、HGB数值,均无统计学差异。灌注前后TBIL和IBIL水平比较,差异无统计意义。灌注过程中每小时检测溶血率均为0。Lac从灌注开始的(2.52±0.39)mmol/L下降至灌注结束的(0.35±0.07)mmol/L(P<0.05)。Glu在第2小时达到最高值(21.37±5.96)mmol/L,灌注结束时下降至(9.78±2.63)mmol/L(P<0.05)。结论离体肝脏常温机械灌注设备能够维持HCT和HGB稳定,不会导致溶血;过程中Lac和Glu持续消耗,间接反映了灌注过程红细胞携氧能力可以改善离体肝脏功能。Objective To establish the normothermic machine perfusion(NMP)device for extracorporeal liver and explore the effect of NMP on the erythrocyte.Methods Liver and blood were derived from healthy female Bama miniature pigs.The extracorporeal liver was continuously perfused for 8 hours by normothermic perfusion equipment.During the eight-hour perfusion,temperature was set at 37℃and the arterial pressure was set at 80/60 mmHg,and the portal vein was set at a constant flow mode(0.5 mL/min•g).The temperature of the perfusion fluid,the flow rate of hepatic artery and portal vein during the perfusion were recorded.The erythrocyte and other relevant indicators were tested every hour including the hematocrit(HCT),hemoglobin(HGB),total bilirubin(TBIL),indirect bilirubin(IBIL),the hemolytic rate,Lactate(Lac)and Glucose(Glu).Results During perfusion in vitro,the temperature of perfusion fluid was keep stable at 37℃,the hepatic artery flow increased from(54.64±11.94)mL/min to(249.34±93.01)mL/min,while the average portal vein flow was(442.67±79.19)mL/min.At the beginning and the end of perfusion,the concentration of HCT and HGB were(27.67±2.42)%,(9.40±0.81)g/dL,(28.00±2.45)%,(9.52±0.81)g/dL.HCT and HGB at the beginning and end of perfusion were compared respectively,and there was no statistical difference.No statistical difference existed in TBIL and IBIL at the start and the end of perfusion,respectively.And the hemolytic rate was 0 during the perfusion.Lac decreased from(2.52±0.39)mmol/L at the beginning to(0.35±0.07)mmol/L at the end(P<0.05).Glu peaked at 2nd hour,which was(21.37±5.96)mmol/L,and decreased to(9.78±2.63)mmol/L after eight-hour perfusion(P<0.05).Conclusion The NMP device can stably maintain the level of HCT and HGB without hemolysis.Lac and Glu were continuously consumed during perfusion,which indirectly reflected that the oxygen carrying capacity of erythrocyte could improve the liver function in vitro.

关 键 词：常温机械灌注 红细胞 红细胞压积 血红蛋白 胆红素 溶血 乳酸 

分 类 号：R197.39[医药卫生—卫生事业管理]