CAJ | 학술논문

目的探讨小型猪减体积肝移植术中再灌注后综合征(PRS)的发生及干预措施.方法选取大小相近的小型猪24头,供、受体各12头随机配对后分成A组和B组,行减体积肝移植术；A组(干预组)通过肝下下腔静脉废弃最初100 ml门静脉血,而B组(对照组)未废弃,术中均予5％碳酸氢钠(NaHCO3)5 ml/kg静脉滴注；于麻醉后、新肝期前、后及关腹前分别检测动脉血气及电解质；观察术中再灌注后综合征(PRS)的发生及术后1周生存率.结果新肝期时,A组的平均动脉压(MAP)及心率(HR)分别高于和慢于B组(P＜0.05)；再灌注后血钾浓度(K+)与PRS相关,而PRS与不良预后相关；A组再灌注后K+和PRS发生率均显著低于B组(P＜0.05)；B组1周生存率(33.3％)显著低于A组(100％)(P＜0.05),分别死于心跳骤停(术中)、急性肺水肿(术后3h)、急性肾衰竭(术后2d)及腹腔出血(术后3d).结论废弃最初的门静脉血同时预防性给予NaHCO3,可以有效降低再灌注后K+,减小PRS的发生率,改善术后生存率.
목적 탐토소형저감체적간이식술중재관주후종합정(PRS)적발생급간예조시.방법 선취대소상근적소형저24두,공、수체각12두수궤배대후분성A조화B조,행감체적간이식술；A조(간예조)통과간하하강정맥폐기최초100 ml문정맥혈,이B조(대조조)미폐기,술중균여5％탄산경납(NaHCO3)5 ml/kg정맥적주；우마취후、신간기전、후급관복전분별검측동맥혈기급전해질；관찰술중재관주후종합정(PRS)적발생급술후1주생존솔.결과 신간기시,A조적평균동맥압(MAP)급심솔(HR)분별고우화만우B조(P＜0.05)；재관주후혈갑농도(K+)여PRS상관,이PRS여불량예후상관；A조재관주후K+화PRS발생솔균현저저우B조(P＜0.05)；B조1주생존솔(33.3％)현저저우A조(100％)(P＜0.05),분별사우심도취정(술중)、급성폐수종(술후3h)、급성신쇠갈(술후2d)급복강출혈(술후3d).결론 폐기최초적문정맥혈동시예방성급여NaHCO3,가이유효강저재관주후K+,감소PRS적발생솔,개선술후생존솔.
Objective To prevcnt the activation of post-reperfusion syndrome (PRS) in reducedsize liver transplantation in minipigs.Methods Twenty-four minipigs were randomly paired,divided into two groups (group A∶n =6; group B∶n =6) and received reduced-size liver transplantation.Group A allowed the initial 100 ml of portal blood reperfusing hepatic graft to be discarded through the inferior vena cava.Groups A and B were both administered 5％ sodium bicarbonate 5 ml/kg.Blood gas and electrolyte were obtained at preanhepatic phase,anhepatic phase,neohepatic phase and the end of surgery,respectively.PRS and one-week-survival rate were observed in both groups.Results Blood potassium concentration at neohepatic phase was correlated with PRS,while PRS was correlated with poor prognosis after reduced-size liver transplantation.At neohepatic phase,the plasma potassium concentration and PRS rate in group A were significantly lower than in group B (P ＜0.05).As a result,one-week-survival rate (100％) in group A was significantly higher than in group B (only 33.3％) (P ＜ 0.05).Four cases in group B died of cardiac arrest (intraoperation),acute pulmonary edema (3 h postoperation),acute renal failure (2 days postoperation) and intra-abdominal bleeding (3 days postoperation) respectively.Conclusion The abolishment of initial portal vein blood reperfusing graft and venous infusion of 5％ sodium bicarbonate can improve postoperative survival by effectively reducing the potassium concentration after reperfusion and significantly decreasing the incidence of PRS.