门静脉阻断下自制在体冷灌注液对肝脏保护作用的研究

Protective effects of self-made hypothermic perfusate in vivo on liver during occlusion of portal vein

目的研究经门静脉在体灌注自制灌注液对长时间门静脉阻断下肝脏的保护作用。方法采用人造血管,在肠系膜上静脉、肝下下腔静脉间架桥,建立猪临时性肠腔分流模型。21头巴马猪分3组,门静脉阻断2 h,A组不灌注、B组灌注乳酸林格液、C组灌注自制灌注液,监测各组动物术中HR、MAP,对比观察3组动物2 w存活率,在阻断前、复流前、复流2 h、术后1、3、5 d检测ALT、AST、TBIL的变化;对应时相点切取肝组织,在光镜、电镜下观察肝脏病理变化。结果 3组动物存活率均为100%,C组ALT、AST、肝组织形态学变化明显较A、B两组轻。结论自制保护液能安全进入体循环。经门静脉在体灌注自制灌注液对因门静脉血流长时间阻断导致的肝缺血再灌注损伤具有良好的保护作用。自制灌注液的肝保护作用明显优于乳酸林格液。

Objective To investigate the protective effects of portal vein perfusion with self - made hypothermic perfusate in vivo on liver during long time occlusion of portal vein. Methods A porcine provisional model of mesocaval shunt was made by establishmen of a bridge between superior mesenterie vein and hepatic inferior vena cava with an artificial blood vessel. And 21 Bama swines were divided into 3 groups which all underwent occlusion of portal vein for 2 h. Group A was not perfused, group B was perfused with Ringer lactate solution and group C was perfused with self - made hypothermic perfusate. The intraoperative HR and MAP of the animals in the three groups were monitored. Their survival rates within 2 w were compared, and the changes of ALT, AST and TBIL before the occlusion,before the reflow,2 h after the reflow,and 1,3 and 5 d after the operation were detected. Hepatic tissues samples were obtained at the above time points and the hepatic pathological changes were observed under the light microscope and electron microscope. Results The survival rates of the animals in the three groups within 2 w were all 100%. Compared with group C, tile changes of ALT, AST and hepatic histomorphology in group A and B were more obvious. Conclusion The self - made perfusate can be safely perfused into the systemic circulation. The portal vein perfusion with self - made perfusate has good protective effects on hepatic ischemical reperfusion injury caused by long term occlusion of portal vein. The protective effects of the self - made perfusate on liver are better than those of Ringer lactate solution.