小型猪减体积肝移植术中再灌注后综合征的干预研究

Precaution of postreperfusion syndrome after reduced.size liver transplantation in minipigs

目的探讨小型猪减体积肝移植术中再灌注后综合征（PRS）的发生及干预措施。方法选取大小相近的小型猪24头，供、受体各12头随机配对后分成A组和B组，行减体积肝移植术；A组（干预组）通过肝下下腔静脉废弃最初100ml门静脉血，而B组（对照组）未废弃，术中均予5％碳酸氢钠（NaHCO，）5ml／kg静脉滴注；于麻醉后、新肝期前、后及关腹前分别检测动脉血气及电解质；观察术中再灌注后综合征（PRS）的发生及术后1周生存率。结果新肝期时，A组的平均动脉压（MAP）及心率（HR）分别高于和慢于B组（P〈0．05）；再灌注后血钾浓度（K＋）与PRS相关，而PRS与不良预后相关；A组再灌注后K＋和PRS发生率均显著低于B组（P〈0．05）；B组1周生存率（33．3％）显著低于A组（100％）（P〈0．05），分别死于心跳骤停（术中）、急性肺水肿（术后3h）、急性肾衰竭（术后2d）及腹腔出血（术后3d）。结论废弃最初的门静脉血同时预防性给予NaHCO3，可以有效降低再灌注后K＋，减小PRS的发生率，改善术后生存率。

Objective To prevent the activation of post-reperfusion syndrome （PRS） in reduced- size liver transplantation in minipigs. Methods Twenty-four minipigs were randomly paired, divided into two groups （ group A ： n = 6 ; group B ： n = 6） and received reduced-size liver transplantation. Group A al- lowed the initial 100 ml of portal blood reperfusing hepatic graft to be discarded through the inferior vena tara. Groups A and B were both administered 5% sodium bicarbonate 5 ml/kg. Blood gas and electrolyte were obtained at preanhepatic phase, anhepatic phase, neohepatic phase and the end of surgery, respec- tively. PRS and one-week-survival rate were observed in both groups. Results Blood potassium concentra- tion at neohepatic phase was correlated with PRS, while PRS was correlated with poor prognosis after re- duced-size liver transplantation. At neohepatic phase, the plasma potassium concentration and PRS rate in group A were significantly lower than in group B （P 〈0. 05）. As a result, one-week-survival rate （ 100% ） in group A was significantly higher than in group B （ only 33.3% ） （P 〈0. 05）. Four cases in group B died of cardiac arrest （intraoperation） , acute pulmonary edema （3 h postoperation） , acute renal failure （2 days postoperation） and intra-abdominal bleeding （3 days postoperation） respectively. Conclusion The abol- ishment of initial portal vein blood reperfusing graft and venous infusion of 5% sodium bicarbonate can im- prove postoperative survival by effectively reducing the potassium concentration after reperfusion and signifi- cantly decreasing the incidence of PRS.