猪ED+PVD全胰十二指肠移植围术期胰腺内分泌功能变化及术中管理

Endocrinal changes of the pancreas during the perioperative period of the pancreaticoduodenal transplantation and the management of anesthesia in pigs.

目的研究猪ED+PVD全胰十二指肠移植的麻醉管理措施及围术期胰腺内分泌功能的变化规律。方法健康杂种长白猪40只,两两配对,采用肠内引流(entericdrainage,ED)和门静脉回流(portalvenousdrainage,PVD)的术式建立猪全胰十二指肠移植模型。基础麻醉后行心电监护,硫喷妥钠缓推诱导,暴露声门后静脉注射司可林气管插管,机控呼吸。术中以芬太尼、咪唑安定、哌库溴铵、硫喷妥钠静脉复合维持麻醉。右颈总动脉穿刺置管,连续监测并记录平均动脉压(MAP)、心率(HR)及经皮脉搏氧饱和度(SpO2)。右颈外静脉置管,于以下时点采集静脉血术前、胰腺切除后30min、供胰恢复灌注后30min、术后第1天及术后第3天,分别以GODPOD法及放射免疫法测定血糖及胰岛素、胰高血糖素水平。结果以芬太尼、咪唑安定、哌库溴铵、硫喷妥钠静脉复合的麻醉方法效果满意。在未使用胰岛素的情况下,血糖水平于切胰30min已明显升高(P<0.05),新胰灌注30min升至最高(P<0.05),而相应时点的胰岛素及胰高血糖素水平则呈对应相反的下降趋势,3者均于术后第3天恢复至术前水平(P>0.05)。结论成功建立ED+PVD猪全胰十二指肠移植模型,采用静脉复合麻醉,循环稳定,苏醒迅速。无胰期有效扩容可保证新胰灌注,其内分泌功能在术后3d恢复正常。

Objective To investigate the regularity of the endocrinal changes of pancreas during the perioperative period of the panceaticoduodenal transplantation and management of anesthesia. Methods Forty pigs were matched and assigned randomly to the donor and recipient groups respectively. The model of the panceaticoduodenal transplantation was set up with enteric drainage and portal veinous drainage. After basic anesthesia,the animals were induced with thiopental and intubation was facilitated with succinylcholine intravenously. Then mechanical ventilation was applied, and the anesthesia was maintained with combination of midazolam, fentanyl, pipecuronium and thiopental intravenously. The right external carotid artery was cannulated for blood pressure monitoring, to observe the heart rate and SpO2 simuhaneously. A catheter was inserted through the right jugular vein for blood samples, which were collected for analyzing the level of blood sugar and insulin and glucagon at the following time points：before operation,5min and 30min after the pancreas removed ,just before the reperfusion, 30min after the reperfusion and 1 day after pancreaticoduodenal transplantation. Results The effect of anesthsia was satisfied with combination of midazolam, fentayl, pipecuroniun and thiopental intravenously. The blood sugar increased significantly during the anpancreatic phase, They began to decrease step by step after the graft was refused, and approached to the normal level on the 3rd day after the pancreaticoduodenal transplantation. But the tendency of insulin and glucagons level were contrary at the corresponding points. Conclusion It was reliable to maintain the anesthesia of pancreaticoduodenal transplantation with combination of midazolam, fentayl, pipecuroniun and thiopental intravenously. The circulation was fluctuant obviously during the anpancreatic phase. Enough infusion could maintain circulatory stabilization.The endocrinal function recovered on the 3rd day after the transplantation.