猪肝原位移植术中血液生化指标的变化

VARIATION OF BLOOD BIOCHEMISTRY DURING ORTHOTOPIC LIVER TRANSPLANTATION IN PIGS

目的 观察猪肝原位移植术中血液生化指标的变化。方法 14只健康家猪在全麻下作右侧颈内动脉插管测定动脉血压并抽取血液标本 ,从右侧颈内静脉置管测定中心静脉压。术中输入不含糖的平衡盐液 ,供肝用Collin’s液灌注。在无肝期采用体外静脉转流 ,经左侧股静脉和门静脉插管 ,引流出的血流经体外转流系统输入左侧腋静脉。于手术中不同时点抽取动脉血作血气分析、电解质和血糖测定。结果 在无肝前期 ,血糖水平高于正常并有逐渐升高的趋势 ,其它观察指标均在正常范围内。在无肝期 ,随手术时间的延长 ,动脉血pH逐渐降低 ,碱剩余 (BE)负值加大 ,血液电解质无明显变化 ,血糖明显下降。新肝期 ,随移植肝循环开放 ,酸中毒进一步加重 ,血钾和血糖水平突然明显升高。结论 在猪肝原位移植术中 ,代谢性酸中毒明显且逐渐加重 ,无肝期血糖水平明显降低 。

Objective To observe the changes of blood biochemistry during orthotopic liver transplantation in pigs. [WT5”HZ]Methods [WT5”BZ]Fourteen healthy pigs were anesthetized and intubated, the right carotic artery was cannulated for blood pressure monitoring and blood biochemical sampling. The right internal jugular vein was cannulated for central venous pressure monitoring. No exogenous glucose was administrated during operation, the donor liver was perfused with Collin’s solution. During the anhepatic stage, the veno venous bypass was established, blood was pumped from the portal and femoral veins using an extracorporeal circuit, and returned to the axillary vein. The arterial blood was sampled for monitoring arterial blood gas tensions, Na +,K +,Ca 2+ , and blood glucose levels. [WT5”HZ]Results [WT5”BZ]During preanhepatic stage, blood glucose levels increased progressively, blood electrolytes and acid base balance were stable. During anhepatic stage, pH was decreased, base deficit was increased significantly, blood glucose levels were significantly decreased, blood electrolytes were stable. During neohepatic stage, acidosis became more severe, blood potassium increased abruptly on reperfusin of the grafted liver, blood glucose was higher than that in prehepatic and anhepatic stage. [WT5”HZ]Conclusion [WT5”BZ]During operation of liver transplantation, metabolic acidosis developed progressively, blood glucose decreased in anhepatic stage, blood glucose and potassium increased significantly on reperfusion of the grafted liver.