猪原位肝移植围术期血流动力学及生化代谢变化的研究

A research on hemodynamic and biochemico metabolic changes during orthotopic liver transplantation in pigs

目的 :在体外静脉 -静脉转流下行原位猪肝移植术 ,观察围术期血流动力学及生化代谢和小剂量多巴胺、硝普钠对肾功能的保护作用。 方法 :随机选择健康杂种猪 16头 ,静脉复合麻醉下 ,经右颈外静脉插入 Swan-Ganz导管监测血流动力学 ,自右颈内动脉和颈外静脉采血监测血气和血生化。无肝期采用门静脉与股静脉 Y型连接后 ,再与左颈外静脉连接 ,进行体外静脉 -静脉转流。无肝前期小剂量多巴胺、硝普钠静脉联合用药并观察尿量。结果 :无肝期和新肝期血流动力学变化剧烈并伴有代谢性酸中毒 ;血清 K+ 在新肝期有一过性升高 ;未出现少尿或无尿。结论 :原位肝移植术中即使应用体外静脉 -静脉转流术仍有血流动力学、酸碱及电解质的显著变化 ,小剂量多巴胺与硝普钠联合应用有助于肾功能维护。

Objective:Changes of hemodynamics,blood biochemistry and renal function protection with small doses of dopamine,sodium nitroprusside were observed during orthotopic liver transplantation(OLT) in pigs under veno venous bypass. Method:16 healthy pigs were performed OLT by general intraveneous anesthesia. Swan ganz catheter was inserted into right external carotid vein for measurement of hemodynamic parameters and right internal carotid artery and right external carotid vein were cannulated for blood pressure monitoring,blood gas analysis and biochemistry tests. A veno venous bypass was performed by femoral and portal vein connections with Y shaped way,then to be joined to the left carotid vein during ahepatic stage. In preahepatic stage,small doses of dopamine and sodium nitroprusside were given by venous pump for the protection of renal function. Results: The hemodynamics and pH level decreased significantly in both ahepatic and neohepatic stages. In addition,a transient increase of serum potassium level was observed in neohepatic stage,No oliguresis occurred during operation. Conclusion: Although veno venous bypass was applied in OLT,hemodynamics and acid bases and electrolyte equilibrium changed significantly. Application of small doses of dopamine and sodium nitroprusside may be useful for the protection of renal function.