猪原位肝移植术中血流动力学与血生化的变化

Variation of hemodynamics and blood biochemistry during orthotopic liver transplantation in pigs

目的：在体外静脉转流下行原位肝移植术，观察其血流动力学及血生化指标的变化。方法：选择健康家猪４８头，体重１７．５～２５ｋｇ，静脉麻醉下，经右颈外静脉插入Ｓｗａｎ－Ｇａｎｚ导管监测血流动力学，取右颈总动脉血测血生化指标。无肝期采用体外静脉转流，即门静脉与股静脉丫型连接后，再与左腋静脉连接。结果：体外静脉转流量达４５０±１００ｍｌ／ｍｉｎ的４０例，整个过程其血流动力学波动较小，血气指标变化轻微，但新肝期血Ｋ＋、糖、肌酐及Ｃａ２＋水平均有不同程度的增高；体外静脉转流量小于２５０ｍｌ／ｍｉｎ的８例，术中其血流动力学不能维持，均死亡。此外转流期预防性应用小剂量肝素，并不影响转流后凝血功能。结论：在原位肝移植过程中，良好的体外静脉转流对维持血流动力学及血生化的稳定有重要意义。

Objective:The Changes of hemodynamics and blood biochemistry were observed during liver transplantation under veno venous bypass. Methods:The study was performed on elected 48 health pigs under intravenous anesthesia.The Swan Ganz catheter was inserted through the right jugular vein for measurment of hemodynamic parameters.The right carotic artery were cannulated for blood pressure monitoring and blood biochemical samples.The veno venous bypass ,which was portal and femoral vein were connected with Y shaped way,then joined to the left axillas vein,was established during anhepatic stage.Results:In 40 pigs with bypass flow rate at 450±100 ml/min ,there were no significant changes in hemodynamics and blood gases while the levels of K +,glucose,Cr and Ca 2+ in the blood increased to different degrees.However in another 8 pigs the bypass flow rate was less than 250 ml/min,the hemodynamics were very unstable during operative period,all of 8 pigs died.The small dose of heparin administration did not interfere with the blood coagulation.Conclusion:It is significantly important with better bypass flow rate to maintain the hemodynamics and blood biochemistry stable during orthotopic liver transplantation.