无肝期控制输血量改善猪背驮式原位肝移植门静脉淤血

Limiting blood transfusion during anhepatic state to improve blood stasis of the portal vein system in piggback orthotopic liver transplantation

目的 探讨输血量对背驮式原位肝移植 (PBOLT)无肝期门静脉淤血的影响。方法 对 16头猪施行PBOLT ,分别观察非控制输血组 (A组 ,n =8)和控制输血组 (B组 ,n =8)在无肝前期、无肝期和恢复门静脉血流后的平均动脉压 (MAP)、中心静脉压 (CVP)、心率 (HR)及血生化指标。结果 无肝期两个组的CVP及HR的差异无显著性 ,而A组的MAP则明显低于B组 (P <0 .0 1) ;在恢复门静脉血流后A组的MAP、CVP、HR均低于B组 (P <0 .0 5 ,P <0 .0 1) ;B组各期的MAP、CVP、HR均较为平稳 ;在无肝期和恢复门静脉血流后 ,A组的血K+明显高于B组 (P <0 .0 5 ) ,二氧化碳结合率 (CO2 CP)明显低于B组 (P <0 .0 5 )。结论 在PBOLT中 ,无肝期控制输血量可减轻门静脉系统淤血 。

Objective To investigate the effect of blood transfusion on blood stasis of the portal vein system during anhepatic state in piggback orthotopic liver transplantation (PBOLT). Methods Sixteen cases undergoing PBOLT were equally divided into two group: uncontrolled blood transfusion group (group A) and controlled blood transfusion group (group B). During pre anhepatic, anhepatic and neohepatic states, mean artery pressure (MAP), central vein pressure (CVP), heart rate (HR), liver function test (LFT) and hydrolytes were observed and the degree of the gastrointestinal tract gore was examined. Results There was no significant difference in CVP and HR between group A and group B during pre anhepatic state ( P > 0.05 ),but MAP in group A was significantly lower than that in group B ( P < 0.05 ).MAP, CVP and HR were significantly lower in group A than those in group B ( P < 0.01 ). The concentration of blood K + was obviously higher in group A than in group B ( P < 0.05 ), while carbon dioxide combining power (CO 2CP) was obviously lower in group A than in group B ( P < 0.05 ). Conclusions Controlled blood transfusion and liquid transfusion might be an effective method to reduce gore of the portal vein system and maintain hemodynamics steady during anhepatic state in PBOLT.