CAJ | 학술논문

目的探讨应用体外膜肺氧合(ECMO)对心脏死亡猪肝脏的保护作用.方法选取巴马小型猪15只,建立猪心脏死亡模型.猪心脏死亡后迅速通过腹主动脉及下腔静脉置入ECMO插管,持续行ECMO 2 h,并持续监测猪的生命体征、肝脏血流,检测血乳酸和肝功能指标,观察肝脏病理组织学变化.结果所有实验猪均成功建模,建模过程中肝脏无胆汁形成,平均动脉压迅速降至30 mmHg以下,直至心肺复苏结束.应用ECMO过程中,肝脏有持续胆汁形成,猪肝脏血流迅速增加,由心脏死亡时的0至ECMO运行15 min时已达基础值的72.9％,之后呈逐渐上升趋势.运行ECMO 30 min时,血乳酸、ALT及AST水平分别为(12.8±2.4) mmol/L、(79.5±65.8) IU/L和(632.2±571.1) IU/L,至运行ECMO 2 h时,血乳酸、ALT及AST水平分别为(12.1±2.8)mmol/L、(55.9±38.6)IU/L和(412.2±431.9)IU/L,与运行ECMO 30 min时比较,运行ECMO 2 h时ALT和AST水平均显著降低(P＜0.05),乳酸水平亦有所下降,但差异无统计学意义(P＞0.05).病理检查可见,猪心脏死亡时肝窦阻塞,弥漫性肝细胞水样变性,应用ECMO后,肝细胞水样变性减轻;透射电镜下可见,猪心脏死亡时肝细胞胞浆内大量空泡形成,细胞核明显变形,染色质边集,线粒体肿胀,应用ECMO后,胞浆内空泡减少,细胞核变形、染色质边集及线粒体肿胀减轻.结论 ECMO对猪心脏死亡后肝脏具有显著的保护作用,可以明显改善心脏死亡猪的肝脏质量及功能.
목적 탐토응용체외막폐양합(ECMO)대심장사망저간장적보호작용.방법 선취파마소형저15지,건립저심장사망모형.저심장사망후신속통과복주동맥급하강정맥치입ECMO삽관,지속행ECMO 2 h,병지속감측저적생명체정、간장혈류,검측혈유산화간공능지표,관찰간장병리조직학변화.결과 소유실험저균성공건모,건모과정중간장무담즙형성,평균동맥압신속강지30 mmHg이하,직지심폐복소결속.응용ECMO과정중,간장유지속담즙형성,저간장혈류신속증가,유심장사망시적0지ECMO운행15 min시이체기출치적72.9％,지후정축점상승추세.운행ECMO 30 min시,혈유산、ALT급AST수평분별위(12.8±2.4) mmol/L、(79.5±65.8) IU/L화(632.2±571.1) IU/L,지운행ECMO 2 h시,혈유산、ALT급AST수평분별위(12.1±2.8)mmol/L、(55.9±38.6)IU/L화(412.2±431.9)IU/L,여운행ECMO 30 min시비교,운행ECMO 2 h시ALT화AST수평균현저강저(P＜0.05),유산수평역유소하강,단차이무통계학의의(P＞0.05).병리검사가견,저심장사망시간두조새,미만성간세포수양변성,응용ECMO후,간세포수양변성감경;투사전경하가견,저심장사망시간세포포장내대량공포형성,세포핵명현변형,염색질변집,선립체종창,응용ECMO후,포장내공포감소,세포핵변형、염색질변집급선립체종창감경.결론 ECMO대저심장사망후간장구유현저적보호작용,가이명현개선심장사망저적간장질량급공능.
Objective To study the protective effect of extracorporeal membrane oxygenation (ECMO) on liver graft after cardiac death in pigs.Method Fifteen mini-pigs were used to establish cardiac death model.After cardiac arrest,abdominal aorta and inferior vena cava were cannulated immediately,then connected to ECMO circuit for 2 h.During this procedure,vital signs and hepatic flow were monitored continuously,and lactate,liver biochemistry and biopsy were tested intermittently.Result Cardiac death models were established successfully in all of the pigs with no bile production during the whole procedure,and mean arterial blood pressure was decreased rapidly below 30 mmHg (1 mmHg =0.133 kPa) till the end of cardiopulmonary resuscitation.There was continuous bile production during ECMO,and the hepatic flow of liver graft was increased rapidly from 0 at the cardiac arrest to 72.9％ of the baseline flow after 15 min of ECMO and increased gradually afterwards.Thirty min after ECMO,lactate,alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were (12.8 ± 2.4) mmol/L,(79.5 ± 65.8) IU/L and (632.2 ± 571.1) IU/L respectively.Two h after ECMO,lactate,ALT and AST were (12.1 ± 2.8) mmol/L,(55.9 ± 38.6)IU/L and (412.2 ± 431.9) IU/L respectively,and ALT and AST levels were significantly lower than those 30 min after ECMO (P＜0.05),while lactate was lower but without significant difference (P＞0.05).Light microscopy indicated congested hepatic sinusoids and diffuse hydropic changes in the hepatocytes after cardiac death,which were alleviated during ECMO.Electromicroscopy revealed numerous vacuoles in cytoplasm,deformated nucleus with gathered chromatin,and round mitochondria.All of these abnormalities were alleviated during ECMO.Conclusion ECMO has protective effect on liver graft after cardiac death in pigs,and could improve its function significantly.