摘要
背景:原位肝移植术中供肝再灌注早期容易出现缺血再灌注综合征,它是导致移植后原发肝功能衰竭和患者死亡的首要原因,其严重程度与下腔静脉阻断时间长短密切相关。研究表明经典原位肝移植术中下腔静脉逆灌注法可缩短下腔静脉阻断时间。目的:进一步观察经典非静脉转流原位肝移植术中下腔静脉逆灌注法对新肝循环再灌注期血流动力学的影响,并与常规门静脉正向灌注法进行对比。设计、时间及地点:病例对比观察,于2006-12/2007-06在解放军南京军区福州总医院完成。对象:选择全身麻醉下行经典非静脉转流原位肝移植术患者39例。方法:将39例经典原位肝移植患者按灌注方法分为2组,19例患者采用下腔静脉逆灌注法,20例患者采用门静脉正向灌注法。主要观察指标:观察两组患者移植前、无肝期、新肝期的有创收缩压、舒张压、心率、中心静脉压等血流动力学指标;记录供肝复温缺血时间。结果:①下腔静脉逆灌注组患者的供肝复温缺血时间短于门静脉正向灌注组(P<0.05)。②新肝开放1min,新肝期5,10,15min下腔静脉逆灌注组患者的收缩压、舒张压、心率变化程度均小于门静脉正向灌注组(P<0.05);新肝期5,10min下腔静脉逆灌注组的中心静脉压低于门静脉正向灌注组(P<0.05)。结论:与传统门静脉正向灌注法相比,经典非静脉转流原位肝移植术中的下腔静脉逆灌注法可明显缩短供肝复温缺血时间,维持更平稳的血流动力学指标,有利于改善移植肝功能的恢复。
BACKGROUND： Ischemic reperfusion syndrome occurs in early donor liver reperfusion after orthotopic liver transplantation. It is the most important cause for liver function failure and patient death. Ischemic reperfusion severity is closely related to blocking of inferior vena cava period. Some studies demonstrate that inferior vena retrograde perfusion can shorten the blocking time during liver transplantation.
OBJECTIVE： To observe the effect of retrograde perfusion on the hemodynamics in orthotopic liver transplantation without venovenous bypass during neohepatic reperfusion phase.
DESIGN, TIME AND SETTING： Case comparison was performed at Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from December 2006 to June 2007.
PARTICIPANTS： Thirty-nine patients underwent orthotopic liver transplantation without venovenous bypass under general anesthesia.
METHODS： According to perfusion methods, the patients were divided into two groups： retrograde perfusion through inferior vena cave （n=19）, and perfusion through portal vein （n=20）.
MAIN OUTCOME MEASURES： The systolic blood pressure, diastolic blood pressure, heart rate, central venous pressure and other hemodynamic parameters were measured before operation, and at anhepatic phase and primary neohepatic phase. The rewarming ischemia time of grafted liver was also recorded.
RESULTS. The rewarming ischemia time of grafted liver in the retrograde perfusion through inferior vena cave group was significantly less than that in the perfusion through portal vein group （P 〈 0.05）. The changes in systolic blood pressure, diastolic blood pressure, and heart rate in patients undergoing retrograde perfusion through inferior vena cave were significantly less than the perfusion through portal vein group atl minute perfusion, 5, 10, and 15 minutes of anhepatic phase （P 〈 0.05）, and the central venous pressure was significantly lower than the perfusion through portal vein group at 5 and 10 minutes of anhepatic phase （P 〈 0.05）.
CONCLUSION： Compared with traditional perfusion through portal vein, the retrograde perfusion in the orthotopic liver transplantation without venovenoous bypass is useful to protect liver function by reducing the fluctuation of hemodynamics and the rewarming ischemia time of grafted liver.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第31期6015-6018,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
