大鼠减体积肝移植术中的呼吸停止

Recipient respiratory arrest during reduced-size liver transplantation in rats

背景:大鼠减体积肝移植模型的成功建立是进行相应实验的基础和前提条件,呼吸停止是影响大鼠减体积肝移植模型成功建立的主要因素之一,对呼吸停止的分析和急救有助于提高模型建立的成功率。目的:探讨大鼠减体积肝移植术中呼吸停止的原因及急救处理。方法:实验选用SD大鼠,供体为雌性,受体为雄性,均采用乙醚吸入麻醉;供体采用单人裸眼操作,在取肝的过程中即进行减体积操作;受体采用双人裸眼配合操作,采用改良的门静脉和肝下下腔静脉双袖套法,胆管支撑管法建立大鼠减体积的稳定模型。对受体术中呼吸停止随即分成3组进行抢救:实验组1采用"简易人工呼吸"加胸外按压的急救方法;实验组2采用单纯的"简易人工呼吸"的方法;对照组采用单纯的胸外按压的急救方法。结果与结论:成功实施的270对大鼠减体积肝移植模型中,术中因吸入麻醉导致的呼吸停止50只,其原因主要是麻醉过度42只,大量气体栓塞3只,气胸3只,急性肺水肿2只。实验组1、实验组2、对照组大鼠呼吸停止后急救成功率分别为84.6%(22/26),54.5%(6/11),30.8%(4/13);对于因吸入麻醉过度导致的呼吸停止,实验组1急救的成功率为95.6%(22/23)。实验组2抢救成功率为66.7%(6/9)。对照组复苏成功率为40%(4/10)。结果表明,大鼠减体积肝移植术中呼吸停止的原因主要是麻醉过度,其次是大量气体栓塞、气胸和急性肺水肿;简易的人工呼吸加胸外按压对于因吸入麻醉过度导致的术中呼吸停止的抢救最有效,其次为单纯的人工呼吸和单纯的胸外按压。

BACKGROUND：It is the foundation and prerequisite for relative experimental research that whether reduce-size liver transplantation in rat was established successfully.Respiratory arrest is the main cause effecting on rat model of reduce-size liver transplantation.It is important to rise succeed rate of rat-reduce-size liver transplantation by analyzing cause and emergency treatment of intra-operation respiratory arrest.OBJECTIVE：To analyze cause of respiratory arrest during reduce-size liver transplantation of the rat and to investigate emergency treatments for respiratory arrest.METHODS：Healthy SD rats were selected.Female rats served as donors and the male rats served as recipients.Operation of donor was performed by only one person with the naked eye, which reduced-size donor liver was performed in the donor operation.Operation of the receptor was performed by two persons with the naked eye, with improved dual-cuff technique of Kamada and stay pipe of biliary tract.The recipients with respiratory arrest were divided into 3 groups as follows：Experimental group 1：the recipients with respiratory arrest accepted ＂simple equipped artificial respiration＂ and external chest compression; Experiment group 2：the recipients with respiratory arrest only accepted ＂simple equipped artificial respiration＂; Control group：the recipients with respiratory arrest only accepted external chest compression.RESULTS AND CONCLUSION：A total of 270 rats were accepted reduce-size liver transplantation successfully, 50 of 270 rats underwent intra-operative respiratory arrest, the cause of intra-operative respiratory arrest as follows：42 rats showed anesthesia overdose, 3 rats showed excessive gas embolism, 3 rats showed pneumothorax and 2 rats showed acute pulmonary edema.The success rates of emergency treatment for respiratory arrest in the experimental group 1, experimental group 2, and the control group were：84.6% （22/26）, 54.5% （6/11）, and 30.8% （4/13）, respectively.The success rate of emergency treatment for anesthesia overdose-induced respiratory arrest in the experimental group 1, experimental group 2, and the control group were was 95.6% （22/23）, 66.7﹪（6/9）, and 40% （4/10）, respectively.The most common respiratory arrest cause during reduce-size liver transplantation of rat was anesthesia overdose, then excessive gas embolism, pneumothorax and acute pulmonary edema in proper order.The most effective emergency treatment of respiratory arrest of rats was ＂simple equipped artificial respiration＂ and external chest compression, then ＂simple equipped artificial respiration＂ and external chest compression in proper order.