离体肝脏双泵双氧合机械灌注设备应用于猪肝脏常温机械灌注的可行性研究  

Feasibility study of isolated liver dual-pump and dual-oxygenator mec-hanical perfusion device for normothermic machine perfusion of pig liver

作　　者：邝伟键 谭晓宇 何锡然 刘华敏 张琳 郭家钘 陈素平 霍枫 KUANG Wei-jian;TAN Xiao-yu;HE Xi-ran;LIU Hua-min;ZHANG Lin;GUO Jia-xing;CHEN Su-ping;HUO Feng(Department of Biomedical Sciences,Guangdong Shunde Industry Design Institute(Guangdong Shunde Innovative Design Institute),Foshan 528311,Guangdong Province,China;Department of Hepatobiliary Surgery,General Hospital of Southern Theater Command,Guangzhou 510010,China;Department of Research and Development,Guangdong Devocean Medical Instrument Co.,Ltd.,Foshan 528311,Guangdong Province,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)生物医学部,广东佛山528311 [2]南部战区总医院肝胆外科,广州510010 [3]广东丁沃生医疗器械有限公司研发部,广东佛山528311

出　　处：《医疗卫生装备》2021年第5期1-5,20,共6页Chinese Medical Equipment Journal

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:探讨自主研发的离体肝脏双泵双氧合机械灌注设备DEVOCEAN-LIVER 2000在离体猪肝脏常温机械灌注上的安全性与可操作性。方法:从45~50 kg雌性巴马小型猪获取供肝,使用DEVOCEAN-LIVER 2000,采用恒压模式对动脉和门静脉进行常温机械灌注6 h,使用雅培iSTAT-300G血气分析仪对每小时的灌注液进行分析,同时利用微纳芯Pointcare V2对灌注液进行生化检测。实时记录并比较灌注过程中动脉和门静脉流量、动脉血液pH值、胆汁生成量、转氨酶、血糖、乳酸、总胆红素的变化。灌注前后,切取肝脏组织制作病理切片,观察肝脏组织形态的变化。采用SPSS 23.0统计学软件进行实验数据分析。结果:灌注过程中,动脉流量及门静脉流量随灌注时间平稳增长;动脉血液pH值一直维持在7.2~7.5;胆汁持续性生成,最高峰可达0.0085 mL/[h·g(肝重)];灌注液中的谷丙转氨酶(ALT)和谷草转氨酶(AST)小幅增加;血糖总体呈现平稳下降状态;乳酸水平整体呈下降趋势,灌注前与灌注6 h的乳酸水平相比差异有统计学意义(P<0.05);灌注前后胆红素变化不明显(P>0.05)。灌注结束后,肝脏外观无明显瘀斑,显微镜下肝小叶结构完整。结论:DEVOCEAN-LIVER 2000能为肝脏提供6 h稳定的体外常温机械灌注,使肝脏在体外仍然保持活性,并且有效改善肝脏微循环,具有良好的安全性与可操作性。Objective To verify the operability and safety of a self-developed isolated liver mechanical perfusion device with dual pumps and dual oxygenators(DEVOCEAN-LIVER 2000)in normothermic machine perfusion of pig liver.Methods Livers from female Bama minipigs weighed 45 to 50 kg had their hepatic arteries and portal veins undergoing 6 h normothermic machine perfusion using DEVOCEAN-LIVER 2000 in constant pressure mode.Hourly perfusions were analyzed using Abbott iSTAT-300G blood gas analyzer,while biochemical tests were carried out on perfusions using MNCHIP Pointcare V2 Veterinary biochemistry analyzer.Changes in arterial and portal flow,arterial blood pH,bile production,transaminases,blood glucose,lactate and total bilirubin were recorded and compared in real time during perfusion.Before and after perfusion,liver tissues were excised to make pathological sections to observe the changes in liver tissue morphology.SPSS 23.0 statistical software was used for the analysis of experimental data.Results During perfusion,arterial flow and portal veins flow increased steadily with perfusion time;arterial blood pH was maintained at 7.2-7.5;bile production was continuous,with a peak of 0.0085 mL/[h·g(liver weight)];alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in the perfusion fluid increased slightly;blood glucose showed a steady decrease in general;an overall decreasing trend was observed in lactate level,and there were statistical significant differences between lactate levels before perfusion and 6 h after(P<0.05);the change in bilirubin before and after perfusion was not significant(P>0.05).At the end of perfusion,the appearance of the liver was free of obvious petechiae and the structure of the liver lobules was intact under microscopy.Conclusion DEVOCEAN-LIVER 2000 provides 6 h of stable in vitro normothermic machine perfusion of the liver,which allows the liver to remain active in vitro and improves hepatic microcirculation with high safety and operability.

关 键 词：常温机械灌注 机械灌注设备 离体肝脏 DEVOCEAN-LIVER 2000 肝脏保存 肝移植 

分 类 号：R318[医药卫生—生物医学工程] R657.3[医药卫生—基础医学]