背驮式原位肝移植术无肝期门静脉血气与血生化的变化

目的观察背驮式原位肝移植术无肝期门静脉血气与生化的变化，为新肝期体循环血气及生化变化寻找依据。方法12例行背驮式原位肝移植术病人开腹后游离出肠系膜上静脉置入导管，在切除痛肝门脉阻断前（T1）、门脉阻断30min（T2）、门脉开放前（T3）、门静脉开放后即可（T4）、门静脉开放后10min（T5）分别抽取上腔静脉血和门静脉血行血生化检查和血气分析。比较同一时点门静脉血与体循环静脉血血气与电解质变化，并比较不同时点门静脉血与体循环静脉血各自的血气与电解质变化。结果门静脉阻断后门静脉血K^＋、乳酸值T2，T3，T4都明显高于T1（P〈0．05），且T4与T3相比较差异有统计学意义（P〈0．05）。pH值在门静脉阻断后逐渐降低，到开放后（T4）降到最低（P〈0．05），且在门静脉开放后与开放前相比较，差异有统计学意义（P〈0．05）。K^＋、乳酸、pH值三者都在T5时刻恢复到术前水平。门静脉阻断后体循环K’浓度在开放后T4明显高于开放前T3（P〈0．05）。pH值在开放后T4明显低于开放前T3（P〈0．05）。乳酸值从T2开始明显升高（P〈0．05），到T4时刻最高（P〈0．05），且在门静脉开放后（T4）明显高于开放前（T3）（P〈0．05）。三者都在T5时刻恢复到术前水平。结论背驮式原位肝移植术在无肝期门静脉阻断和部分阻断下腔静脉的情况下，门静脉系统酸性代谢产物和血钾浓度将随门静脉阻断时间的延长而升高，从而在新肝开放后加重体循环一过性高钾和酸中毒。

The Study of Portal Vein Biochemistry and Blood Gas Analysis at the Time of Anhepatic Phase during the Orthotopic Liver Transplantation

Objective To observe the changes of portal vein biochemistry and blood gas analysis by comparison with the system vein blood at the time of anhepatic phase during the orthotopic liver transplantation. Methods Twelve patients with end-stage liver disease undergoing the orthotopic liver transplantation under general anesthesia were enrolled in this research. Blood samples were separatly taken from system vein and portal vein for biochemistry and blood gas analysis at several time points, such as, before portal vein was clamped（T1 ） , 30 min after portal vein was clamped（T2） ,before portal vein was unclamped（ T3）, the point portal vein was umclamped（ T4）, 10 min after portal vein was unclamped（ T5 ） ,and the concentration of K^ ＋ ,Lactic acid and PH were separatly recorded. Results （1）portal vein ： the concentration of K^＋ ,Lactic acid of the T2 T3 T4 was increased significantly by comparison with T1 （ P 〈 0.05 ） , and there was significant difference about the pH between T4 and T3 （ P 〈 0.05 ）. （2）the system vein blood ： there was no significant difference about the concentration of K^ ＋ and pH between T2 and T1 （ P 〉 0.05 ）, but there was opposite result between T4 T3 and T1 （ P 〈 0.05 ）. The concentration of K^＋ was significantly increased from T3 to T4 （ P 〈 0.05 ）. The concentration of Lactic acid was contiously signicantly increased from T1 to T4 （ P 〈 0.05 ）. （3） The concentration of K^ ＋ , Lactic acid and pH were significant different between portal vein blood and the system vein blood at the T2 T3 T4 （ P 〈0.05 ）. Conclusion At the point the portal vein was unclamped the concentration of K^＋ of in the system vein blood was significant increased by comprasion with before the point,and the high concentration of K^＋ in portal vein blood play an impoint role for the result.