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供体腹主动脉行肝动脉重建对猪肝移植血流动力学和心肌肌钙蛋白Ⅰ的影响
引用本文:黄国勇,黄小彬,刘天奇,李静,黄中华,梁宁. 供体腹主动脉行肝动脉重建对猪肝移植血流动力学和心肌肌钙蛋白Ⅰ的影响[J]. 现代医药卫生, 2012, 28(16): 2404-2407
作者姓名:黄国勇  黄小彬  刘天奇  李静  黄中华  梁宁
作者单位:1. 广西壮族自治区人民医院麻醉科,广西南宁,530021
2. 广西壮族自治区人民医院肝胆外科,广西南宁,530021
基金项目:广西自然科学基金资助项目(桂科回0731010、桂科回0639011); 广西卫生厅自筹课题(Z2007156、Z2007150)
摘    要:目的 观察以供体腹主动脉重建肝动脉对受体血流动力学和心肌肌钙蛋白Ⅰ(cTnI)的影响.方法 将健康广西巴马小型猪12头随机分为供、受体两组,每组6头,受体再随机分为A组(肝动脉吻合组)和B组(腹主动脉吻合组)),每组3头.供、受体动物均接受静脉全身麻醉,气管插管后行机械通气.供体动物行快速肝脏切取术取出供肝.受体动物置入Swan-Ganz导管,行背驮式肝移植术,A、B组采用不同的肝动脉重建方式,A组在不阻断腹主动脉下采用肝动脉端端连续吻合,B组在阻断腹主动脉后以其腹主动脉侧壁和供肝腹主动脉行端侧吻合.检测开腹前5 min (T0)、无肝期30min (T1)、新肝期30 min (T2)、肝动脉重建后10 min (T3)、术毕时(T4)、术后1 h(T5)6个时间点的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、肺动脉压(PAP)、肺动脉楔压(PCWP)、心排量(C0)等血流动力学参数和cTnI.结果 在T0~T2时,组间各指标无差别;在T3时点,B组HR、CO低于A组,MAP、CVP、PAP、PCWP高于A组,cTnI组间无差别;在T4、T5时,B组MAP低于A组,CVP、PAP、PCWP、cTnI高于A组,HR、CO组间无差别.结论 采用完全阻断腹主动脉和以腹主动脉行端侧吻合的肝动脉重建方式加重了血流动力学的变化和心肌损伤.

关 键 词:肝移植  血流动力学  肌钙蛋白Ⅰ  主动脉,腹  肝动脉/外科学  心肌/病理学  

Effects of hepatic artery reconstructionon by donor abdominal aorta on hemodynamics and cardiac troponin-I during pig liver transplantation
Huang Guoyong , Huang Xiaobin , Liu Tianqi , Li Jing , Huang Zhonghua , Liang Ning. Effects of hepatic artery reconstructionon by donor abdominal aorta on hemodynamics and cardiac troponin-I during pig liver transplantation[J]. JOURNAL OF MODERN MEDICINE & HEALTH, 2012, 28(16): 2404-2407
Authors:Huang Guoyong    Huang Xiaobin    Liu Tianqi    Li Jing    Huang Zhonghua    Liang Ning
Affiliation:1.Department of Anesthesia;2.Department of Hepatobiliary Surgery,People′s Hospital of Guangxi Zhuang Autonomous Region,Nanning,Guangxi 530021,China)
Abstract:Objective To observe the effects of hepatic artery reconstruction by donor abdominal aorta on recipient hemodynamics and cardiac troponin I(cTnI) during pig liver transplantation.Methods 12 healthy Bama mini-pigs of Guangxi were randomly divided into he donor group(n=6) and the recipient group(n=6).The recipient group was randomly redivided into the group A(hepatic artery anastomosis group,n=3) and the group B(abdominal aortic anastomosis group,n=3).All animals accepted endotracheal intubation and intraveneous general anesthesia.The donors accepted rapid liver resection,while the recipients accepted classic piggyback liver transplantation after Swan-Ganz catheters were inserted.Hepatic artery reconstruction of group B was different from group A:group A accepted end-to-end anastomosis between hepatic artery of donor and recipient without occluding recipient′s abdominal aorta,and the group B accepted end-to-side anastomosis between abdominal aorta of donor and recipient while occluding recipient's abdominal aorta.The hemodynamic parameters such as mean arterial pressure(MAP),heart rate(HR),central venous pressure(CVP),pulmonary arterial pressure(PAP),pulmonary artery wedge pressure(PAWP),cardiac output(CO) and cTnI were detected at six time points: preoperative 5 min(T0),30 min of anhepatic phase(T1),30 min of hepato-reperfusion phase(T2),10 min after hepatic artery reconstruction(T3),end of operation(T4) and postoperative 1 h(T5).Results There were no differences between the group A and B in cTnI and hemodynamic parameters at time points T0,T1 and T2(P0.05).HR and CO of the group B were lower than those of the group A at T3(P0.05),while MAP,CVP,PAP and PCWP of the group B were higher than those of the group A(P0.05),and there were no differences between groups in cTnI(P0.05).MAP of the group B was lower than that of the group A at T4 and T5(P0.05),while CVP,PAP,PCWP and cTnI of the group B were higher than those of the group A(P0.05),and there were no differences between groups in HR and CO(P0.05).In the trend graph of the hemodynamic parameters changing at time points,the curve fluctuation of the group B was greater than that of the group A.Conclusion The use of donor′s abdominal aorta for hepatic artery reconstruction by end-to-side anastomosis while occluding recipient′s abdominal aorta aggravates the hemodynamics fluctuation and myocardial injury.
Keywords:Liver transplantation  Hemodynamics  Troponin I  Aorta  abdominal  Hepatic artery/surgery  Myocardium/pathology  Swine
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