使用供体腹主动脉行肝动脉重建猪肝移植术的麻醉管理

Anesthetic Management for Liver Transplantation in Pigs with Use of Donor Abdominal Aorta for Hepatic Artery Reconstruction

目的总结使用供体腹主动脉行肝动脉重建猪肝移植术的麻醉管理方法。方法健康广西巴马小型猪10头,随机分成供体组和受体组,每组5头,两组动物均行气管内插管和静脉全身麻醉。供体组动物行快速肝脏切取术取出供肝;受体组动物置入Swan-Ganz导管后行经典背驮式肝移植术,其中肝动脉重建使用供体腹主动脉和受体腹主动脉侧壁行端侧吻合。术中检测受体组动物开腹前5 min(T0)、无肝期30 min(T1)、新肝期30 min(T2)、肝动脉重建后10 min(T3)、术毕时(T4)、术后1 h(T5)6个时点的心率(HR)、平均动脉血压(MAP)、中心静脉压(CVP)、肺动脉压(PAP)、肺动脉楔压(PCWP)、心排量(CO)、血液pH值、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)、剩余碱(BE)、血钠(Na+)、血钾(K+)、血钙(Ca2+)浓度、红细胞比容(Hct)和血红蛋白(Hb)含量等指标。结果采用广西巴马小型猪成功建立了使用供体腹主动脉行肝动脉重建的肝移植动物模型,术中无小猪死亡,手术成功率100%。受体组手术时间为(291.6±52.3)min,无肝期时间为(34.2±13.7)min,肝上下腔静脉吻合时间为(20.3±11.9)min,门静脉吻合时间为(14.2±9.5)min,肝动脉重建时间为(16.4±8.8)min,出血量为(83.8±37.3)ml。手术时血流动力学、血气和电解质等上述15项指标各时点间比较,差异均有统计学意义(P均<0.01)。结论使用供体腹主动脉行肝动脉重建的猪肝移植手术中出现了明显的血流动力学波动、血气变化、酸碱失衡和电解质紊乱,术中麻醉管理应加强监护并根据手术不同阶段的病理生理改变采取针对性的防治措施。

Objective To summarize our experience on anesthetic management for liver transplantation in pigs with use of donor abdominal aorta for hepatic artery reconstruction.Methods Ten healthy Bama mini-pigs of Guangxi were randomly divided into donor group（n=5） and recipient group（n=5）.All animals were accepted endotracheal intubation and intraveneous general anesthesia.The donors received liver resection,while the recipients received classic piggyback liver transplantation after Swan-Ganz catheters were inserted.The end-to-side anastomosis was made for hepatic artery reconstruction between the donors′ abdominal aorta and the recipients′ abdominal aorta.Heart rate（HR）,mean arterial pressure（MAP）,central venous pressure（CVP）,pulmonary arterial pressure（PAP）,pulmonary artery wedge pressure（PCWP）,cardiac output（CO）,blood pH values（pH）,partial pressure of carbon dioxide in arterial blood（PaCO2）,partial pressure of oxygen in arterial blood（PaO2）,base excess（BE）,serum sodium level（Na＋）,serum potassium level（K＋）,serum calcium level（Ca2＋）,hematocrit（Hct） and hemoglobin（Hb） were detected at six time points：5 minutes before operation（T0）,30 minutes of anhepatic phase（T1）,30 minutes of hepato-reperfusion phase（T2）,10 minutes after hepatic artery reconstruction（T3）,the end of operation（T4）,1 hour after operation（T5）.Results The model of liver transplantation in Bama mini-pigs with use of donor abdominal aorta for hepatic artery reconstruction was successfully established and none of the recipients was dead during experiment,the success rate was 100%.The operation time was 291.6±52.3 min,the anhepatic phase time was 34.2±13.7 min,the infrahepatic vena cava anastomosis time was 20.3±11.9 min,the portal vein anastomosis time was 14.2±9.5 min,the time of hepatic artery reconstruction was 16.4±8.8 min,the amount of blood loss was 83.8±37.3 ml.There were significant differences in the detected indices among different time points（all P〈0.01）.Conclusion There are significant changes in hemodynamics,blood gases,acid-base and electrolyte during liver transplantation in pigs with use of donor abdominal aorta for hepatic artery reconstruction.Supervision should be strengthened in anesthetic management during the operation,and the appropriate prevention and treatment measures should be taken out based on the pathophysiological changes in different stages.