CAJ | 학술논문

目的探讨在体体外膜肺氧合(ECMO)对猪心脏死亡30min后肝脏的保护作用.方法长白猪10头,体质量为30～40 kg,随机分为实验组和对照组,麻醉后使用气管夹闭法使心脏停跳30 min,建立心脏死亡热缺血模型.实验组经右侧髂动、静脉置入动、静脉插管,连接ECMO体外循环管道;经左侧髂动脉,置入球囊导管至膈肌平面;启动ECMO建立再循环,灌注腹腔器官;同时调节循环酸碱度及电解质平衡.监测并记录循环流量、腹腔器官灌注压、静脉血液气体、电解质、转氨酶、胆汁量等指标.对照组热缺血30 min后原位冷灌注,UW液中冷储存肝脏.肝脏组织切片HE染色,观察其病理改变.结果热缺血30 min后,肝脏呈现明显的乌黑淤血外观,病理切片显示肝窦扩张,血细胞淤滞,红细胞聚集.循环血液血液气体分析显示严重酸中毒.启动ECMO再循环后,循环流量能够维持在1 L/min,肝脏逐渐恢复鲜红色,病理切片显示肝窦扩张消失,淤滞的血细胞被驱散.经历30 min心脏停跳热缺血后,循环中天冬氨酸转氨酶明显升高至(226.0±28.0)U/L,应用ECMO 4 h后下降至(150.0±30.0)U/L.平均胆汁分泌量为7.75 ml/h.结论 ECMO再循环对心脏停跳30 min的猪肝脏具有保护作用.
목적 탐토재체체외막폐양합(ECMO)대저심장사망30min후간장적보호작용.방법 장백저10두,체질량위30～40 kg,수궤분위실험조화대조조,마취후사용기관협폐법사심장정도30 min,건립심장사망열결혈모형.실험조경우측가동、정맥치입동、정맥삽관,련접ECMO체외순배관도;경좌측가동맥,치입구낭도관지격기평면;계동ECMO건립재순배,관주복강기관;동시조절순배산감도급전해질평형.감측병기록순배류량、복강기관관주압、정맥혈액기체、전해질、전안매、담즙량등지표.대조조열결혈30 min후원위랭관주,UW액중랭저존간장.간장조직절편HE염색,관찰기병리개변.결과 열결혈30 min후,간장정현명현적오흑어혈외관,병리절편현시간두확장,혈세포어체,홍세포취집.순배혈액혈액기체분석현시엄중산중독.계동ECMO재순배후,순배류량능구유지재1 L/min,간장축점회복선홍색,병리절편현시간두확장소실,어체적혈세포피구산.경력30 min심장정도열결혈후,순배중천동안산전안매명현승고지(226.0±28.0)U/L,응용ECMO 4 h후하강지(150.0±30.0)U/L.평균담즙분비량위7.75 ml/h.결론 ECMO재순배대심장정도30 min적저간장구유보호작용.
Objective To investigate the repair function of extracorporeal membrane oxygenation (ECMO) in vivo for the liver after cardiac death with warm ischemia injury for 30 min from cardiac death swinc.Method Ten landraces,30 to 40 kg,randomized to experimental group and control group,were used to make 30-min cardiac death models through clamping trachea after deep anesthesia.An intravenous cannula was placed through right iliac arteries and veins,and connected to ECMO extracorporeal circulation pipes in experimental group.The balloon catheter was placed to diaphragm plane through left femoral artery.The ECMO was performed to infuse abdominal organs,and pH and electrolyte were adjusted.The circulation flow rate,intraperitoneal organ perfusion pressure,venous blood gas,electrolyte,transaminase,and bile product,etc.were monitored and recorded.The livers of control group were retrieved after 30-min cardiac arrest and stored in cold UW for 4 h.Pathological tissue was sliced and stained by HE.Result After 30-min cardiac arrest,the liver showed obvious congestion appearance; pathologically,there were hepatic sinus expansion,blood cells clog,and erythrocyte aggregation.Circulating blood gas analysis revealed severe acidosis.After the ECMO recirculation started,circulation flow rate maintained to 1 L/min,the liver gradually restored bright red,pathological biopsy showed that hepatic sinus expansion disappeared,and clogged blood cells dispelled.AST was markedly increased to (226.0 ± 28.0) U/L after 30-min cardiac arrest and reduced to (150.0 ± 30.0) U/L 4 h after the ECMO recirculation.Average bile production was 7.75 ml/h.Conclusion ECMO recirculation in vivo can repair the injured livers from cardiac death donor with 30-min cardiac arrest.