供肝热缺血与肝移植术后肺损伤关系的实验研究

目的：探讨心脏停搏供体肝移植中，供肝热缺血与肝移植术后肺损伤的关系。方法：实验以供肝获取前经历的心脏停搏时间0、30和60min分为3组，分别为有心跳组（HB组）、心脏停搏30min组（NHBD－30组）和心跳停搏60min组（NHBD－60组），而后行大鼠原位肝移植。比较术后血清中肿瘤坏死因子（TNF）－α细胞间粘附分子－1（ICAM－1）的变化，并观察肺组织病理和肺组织中ICAM－1免疫组织化学表达。结果：随着供肝热缺血时间的延长，肺组织损害也逐渐回重，术后血清中TNF－α和ICAM－1的值呈上升趋势，各组间差异有显著性。术后6h NHBD-60组出现肺组织中ICAM－1的强表达。结论：在心脏停搏供体肝移植中，TNF－α和ICAM－1的表达上调与术后肺组织损伤有关。

Experimental study on relationship between donor liver warm ischemia and pulmonary injury after liver transplantation

Objective To investigate the relationship between donor liver warm ischemia and postoperative pulmonary injury following liver transplantation from non-heart-beating donors. Methods Rat orthotopic liver transplantation was performed on 3 groups in terms of the cardiac arrest time before donor liver harvested: heart-beat (HB) group, 30-min cardiac arrest group and 60-min cardiac arrest group. The serum levels of TNF-a and ICAM-1, the pathological changes of lung, and the immunohistolo-gical expression of ICAM-1 were compared among the groups. Results Postoperative pulmonary injuries were gradually aggravated parallel to warm ischemia time donor liver exposed. Serum levels of TNF-a and ICAM-1 showed an elevated tendency with the difference being very significant among the groups. Six h postoperatively there was strong expression of ICAM-1 in lung tissue in 60-min cardiac arrest group. Conclusion In liver transplantation from cardiac arrest donors, the up-regulation of TNF-a and ICAM-1 was associated with postoperative pulmonary injury.