实验性肝移植中透明质酸的变化

The changes in hyaluronic acid in experimental liver transplantation

目的 通过实验性猪背驮式肝移植手术,观察肝移植手术过程中不同时期受体猪外周血液中透明质酸的变化,以及供体肝脏植入、血流再通、温血再灌注后受体的外周血液中透明质酸变化,并探讨这些变化在肝移植手术中的意义。方法 健康种猪15对,分别抽取手术前、无肝期前、无肝期、新肝期各时点的外周静脉血,经放射兔疫分析法检测透明质酸浓度。结果 手术平均时间(343.33±73.99)min,其中麻醉后至手术开始平均时间为(8.34±21.56)min,收缩压平均下降(23.51±5.87)mm Hg,舒张压平均下降(11.35±7.81)mm Hg,手术开始至无肝期前平均时间为(146.13±41.61)min,无肝期平均时间为(47.07±25.35)min。手术前透明质酸达到267μg/L,无肝期前上升到1743μg/L(P<0.05),无肝期内外周血透明质酸浓度急剧上升,达到9530μg/L,明显较其余各时点高(P<0.01),供体肝脏植入重新开放血流后外周血透明质酸浓度下降至1485μg/L,其变化与ALT和AST有较好的相关性(分别r=0.674 P=0.000和r=0.509 P=0.008)。结论 麻醉过程、麻醉药物以及肝移植手术中各种因素都可以引起外周血液中透明质酸浓度的增高。供体肝脏经过冷灌注保养和温血再灌注后受体的外周血液透明质酸浓度明显增高,并与肝功能的变化有一定的相关性。

Objective To investigate the changes in serum hyaluronic acid level at different periods of experimental piggyback liver transplantation and its significance. Methods Fifteen pairs of healthy pigs of both sexes weighing (28.3 + 5.0)kg undergoing liver transplantation were studied. The donor pigs were slightly smaller than the recipient pigs. The recipient pigs were premedicated with intramuscular ketamine 8mg kg-1 and atropine 0.02mg-kg-1 .Anesthesia was induced with propofol 2mg-kg-1 , fentanyl 0.002mg-kg-1 and vecuronium 0.1mg-kg-1 iv. After tracheal intubation the animals were mechanically ventilated. CVP line was placed via internal jugular vein. Carotid artery was cannulated for continuous BP monitoring. Anesthesia was maintained with iv propofol, fentanyl and vecuronium. Circulatory stability was maintained by infusion of crystalloid, colloid, plasma and whole blood of pig. Blood samples were taken from peripheral vein before operation (T0), pre-anhepatic phase (T1), anhepatic phase (T2) and neohepatic phase (T3) for determination of serum hyaluronic acid concentration by radioimmunoassay. At the same time liver function tests, ALT, AST, y-GT were also examined. Results The average time of liver transplantation was (343+74) min. SBP decreased by (23.51+5.87 ) mm Hg and DBF by (11.35+7.81) mm Hg after induction of anesthesia. Serurn hyaluronic acid level was 267ug-L-1 before operation (T0) and rose to 1743ug-L-1 at T1 , and 9530ug-L-1 at T2 (P<0.05) . When the donor liver was transplanted and reperfused, the serum hyaluronic acid concentration fell to 1485ug-L-1 .After the donor liver was transplanted and reperfused, ALT, AST and y-GT increased significantly as compared with the baseline (T0 ) . The change in serum hyaluronic acid level was well correlated with the changes in ALT andAST. Conclusion Many factors during anesthesia and liver transplantation surgery affect liver function and increase serurn hyaluronic acid concentration. After liver transplantation the changes in hyaluronic acid are well correlated with the changes in some liver function tests like AST and ALT.