肝移植中逆灌注条件下经门静脉血浆冲洗的最佳灌洗量

The optimal volume of plasma to flush out preservation fluid in retrograde reperfusion during liver transplantation

目的探讨肝移植时逆灌注条件下，经门静脉插管灌注冲洗所需血浆的最适量。方法回顾性分析我院2011年1月至2013年10月采用下腔静脉逆灌注法的50例经典原位肝移植患者的病例资料。依据经门静脉灌注血浆量的不同分为两组：组1共27例，经门静脉灌注400ml血浆；组2共23例，经门静脉灌注1200ml血浆。比较两组术前、术中一般情况，动态监测移植过程中不同时间点血清钾、钠、钙浓度、平均动脉压、pH值等指标。记录组2冲洗200ml、400ml、600ml、800ml、1000ml、1200ml时供肝肝下下腔静脉吻合口流出液钾、钠、钙离子浓度。结果两组术前及术中一般情况差异无统计学意义。组1门静脉开放后1min血浆钾离子浓度明显高于组2[（4．31±0．54）mmo]／L比（3．96±0．58）mmol／L，P〈0．05]，而pH值较组2明显减小（7．26±0．02比7．30±0．04，P〈0．05）；两组平均动脉压以及钠、钙离子浓度差异无统计学意义。组2在冲洗血浆量超过200ml后，流出液的钙离子浓度两两比较差异均无统计学意义（P〉0．05）；冲洗超过400ml时，流出液的钠离子浓度两两比较无明显差异（P〉0．05）；钾离子浓度在冲洗至800ml后两两比较差异亦无统计学意义（P〉0．05）。结论在逆灌注条件下，经门静脉低温血浆冲洗量800ml，可使门静脉开放后瞬间循环中的电解质、血压、pH更接近正常，减少灌注性损伤，为最有效、经济的灌洗量。

Objective To determine the optimal volume of plasma that should be used to perfuse through the portal vein （PV） to washout preservation fluid in retrograde repeffusion during liver transplanta- tion. Methods The clinical data of 50 patients who underwent orthotopic liver transplantation （OLT） using retrograde reperfusion via the inferior vena eava （IVC） in our hospital from January 2011 to October 2013 were retrospectively analyzed. The patients were divided into two groups based on the volume of plasma in- fused via the PV to flush out the preservation fluid. Group 1 ： 27 patients who received 400 ml, and Group 2 ： 23 patients who received 1 200 ml. The preoperative and intraoperative data of the two groups were com- pared and analyzed. The serum concentrations of K＋ , Na＋ , Ca2＋ , mean arterial pressure （MAP） and pH were continuously monitored in the transplant recipients at different time points during liver transplantation. In addition, for patients in Group 2, the serum K ＋ , Na ＋ and Ca2 ＋ concentrations in the samples of effluent fluid from the liver grafts were collected via the anastomotic stoma of the infrahepatic IVC and measured after infusion of 200 ml, 400 ml, 600 ml, 800 ml, 1 000 ml, or 1 200 ml of plasma. Results There were no significant differences in the preoperative and intraoperative data between the two groups. The plasma con- centration of K ＋in Group 1 was significantly higher than that of Group 2 at 1 min after PV revascularization （ T3 ） [ （4. 31 ± 0. 54） mmol/L vs （3.96 - 0. 58 ） mmol/L, P 〈 0.051 , while the pH was significantly low- er in Group 1 than that of in Group 2 （7.26 ± 0. 02 vs 7.30 ± 0. 04, P 〈 0. 05 ）. The plasma Na ＋ and Ca2 ＋ concentrations, as well as the MAP, were not significantly different between the two groups at this time point. In group 2, no significant changes were observed in Ca2＋ concentration in IVC blood following perfu- sion of 200 ml plasma. The insignificant changes in Na ＋ after perfusion of 400 ml of plasma and for K ＋ after 800 ml of plasma （ P 〉 0. 05 ）. Conclusions The electrolyte concentrations, blood pressure and arterial blood pH were fairly normal after resuming flow with PV revascularization after a perfusion volume of 800 mlof plasma. This volume was the most appropriate perfusion volume, balancing its effectiveness with economy to wash out any UW solution during OLT using retrograde reperfusion.