中华器官移植杂志
中華器官移植雜誌
중화기관이식잡지
CHINESE JOURNAL OF ORGAN TRANSPLANTATION
2015年
5期
290-294
,共5页
隋明昊%刘蕾%史源%马宁%刘艳%沈中阳
隋明昊%劉蕾%史源%馬寧%劉豔%瀋中暘
수명호%류뢰%사원%마저%류염%침중양
体外膜肺氧合%猪%肝移植
體外膜肺氧閤%豬%肝移植
체외막폐양합%저%간이식
Extracorporeal membrane oxygenation%Pig%Liver transplantation
目的 研究对热缺血30 min的马斯特里赫特Ⅱ类(M-Ⅱ类)供猪应用体外膜肺氧合(ECMO)修复供肝的最佳时间.方法 巴马小型猪36只,采用随机数字表法分为3组,ECMO修复2h组、4h组和6h组,每组12只,供、受猪各6只.供猪以静脉推注氯化钾的方法诱导心跳骤停,给予标准心肺复苏30 min后宣布死亡.经下腔静脉及腹主动脉插管连接ECMO进行自体血循环.2h组、4h组和6h组分别运行ECMO2 h、4h和6h.监测记录肝功能、门静脉和肝动脉血流、动脉血气等指标.取肝组织甲醛固定后切片,HE染色,在光学显微镜下观察病理改变,采用脱氧核糖核苷酸末端转移酶介导的缺口末端标记法(TUNEL)检测肝细胞凋亡,并计算凋亡指数.ECMO运行结束后获取供肝,于UW液中冷保存2h,行原位肝移植手术.术后1～5 d取受猪外周血检测天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)水平.结果 随着ECMO运行时间的增加,肝功能指标和乳酸水平持续降低.ECMO运行结束时,6h组的门静脉血流量低于其他两组,差异有统计学意义(P＜0.05).2h组、4h组和6h的凋亡指数分别为(40.20±7.22)％、(18.60±4.04)％和(29.25±5.98)％,与其他两组比较,4h组凋亡指数显著降低(P＜0.05),且4h组肝组织的病理改变也明显较轻.术后5d,2h组和6h组受猪存活率均为83％,4h组为100％,术后4h组的转氨酶水平低于2h组和6h组,差异有统计学意义(P＜0.05).结论 ECMO修复M-Ⅱ类供肝4h时修复效果较好,修复时间过短修复效果不理想,超出4h后肝脏功能与肝细胞活力出现下降.
目的 研究對熱缺血30 min的馬斯特裏赫特Ⅱ類(M-Ⅱ類)供豬應用體外膜肺氧閤(ECMO)脩複供肝的最佳時間.方法 巴馬小型豬36隻,採用隨機數字錶法分為3組,ECMO脩複2h組、4h組和6h組,每組12隻,供、受豬各6隻.供豬以靜脈推註氯化鉀的方法誘導心跳驟停,給予標準心肺複囌30 min後宣佈死亡.經下腔靜脈及腹主動脈插管連接ECMO進行自體血循環.2h組、4h組和6h組分彆運行ECMO2 h、4h和6h.鑑測記錄肝功能、門靜脈和肝動脈血流、動脈血氣等指標.取肝組織甲醛固定後切片,HE染色,在光學顯微鏡下觀察病理改變,採用脫氧覈糖覈苷痠末耑轉移酶介導的缺口末耑標記法(TUNEL)檢測肝細胞凋亡,併計算凋亡指數.ECMO運行結束後穫取供肝,于UW液中冷保存2h,行原位肝移植手術.術後1～5 d取受豬外週血檢測天鼕氨痠轉氨酶(AST)和丙氨痠轉氨酶(ALT)水平.結果 隨著ECMO運行時間的增加,肝功能指標和乳痠水平持續降低.ECMO運行結束時,6h組的門靜脈血流量低于其他兩組,差異有統計學意義(P＜0.05).2h組、4h組和6h的凋亡指數分彆為(40.20±7.22)％、(18.60±4.04)％和(29.25±5.98)％,與其他兩組比較,4h組凋亡指數顯著降低(P＜0.05),且4h組肝組織的病理改變也明顯較輕.術後5d,2h組和6h組受豬存活率均為83％,4h組為100％,術後4h組的轉氨酶水平低于2h組和6h組,差異有統計學意義(P＜0.05).結論 ECMO脩複M-Ⅱ類供肝4h時脩複效果較好,脩複時間過短脩複效果不理想,超齣4h後肝髒功能與肝細胞活力齣現下降.
목적 연구대열결혈30 min적마사특리혁특Ⅱ류(M-Ⅱ류)공저응용체외막폐양합(ECMO)수복공간적최가시간.방법 파마소형저36지,채용수궤수자표법분위3조,ECMO수복2h조、4h조화6h조,매조12지,공、수저각6지.공저이정맥추주록화갑적방법유도심도취정,급여표준심폐복소30 min후선포사망.경하강정맥급복주동맥삽관련접ECMO진행자체혈순배.2h조、4h조화6h조분별운행ECMO2 h、4h화6h.감측기록간공능、문정맥화간동맥혈류、동맥혈기등지표.취간조직갑철고정후절편,HE염색,재광학현미경하관찰병리개변,채용탈양핵당핵감산말단전이매개도적결구말단표기법(TUNEL)검측간세포조망,병계산조망지수.ECMO운행결속후획취공간,우UW액중랭보존2h,행원위간이식수술.술후1～5 d취수저외주혈검측천동안산전안매(AST)화병안산전안매(ALT)수평.결과 수착ECMO운행시간적증가,간공능지표화유산수평지속강저.ECMO운행결속시,6h조적문정맥혈류량저우기타량조,차이유통계학의의(P＜0.05).2h조、4h조화6h적조망지수분별위(40.20±7.22)％、(18.60±4.04)％화(29.25±5.98)％,여기타량조비교,4h조조망지수현저강저(P＜0.05),차4h조간조직적병리개변야명현교경.술후5d,2h조화6h조수저존활솔균위83％,4h조위100％,술후4h조적전안매수평저우2h조화6h조,차이유통계학의의(P＜0.05).결론 ECMO수복M-Ⅱ류공간4h시수복효과교호,수복시간과단수복효과불이상,초출4h후간장공능여간세포활력출현하강.
Objective To investigate the optimal time of extracorporeal membrane oxygenation (ECMO) on repairing Maastricht Ⅱ pig liver with warm ischemia injury for 30 min.Method Thirty-six miniature pigs were randomized to ECMO 2-h group,ECMO 4-h group and ECMO 6-h group,12 pigs per group,6 donors and 6 recipients.Cardiac arrest was induced by administration of 1 g KCl intravenously,followed by cardiopulmonary resuscitation (CPR) for 30 min according to the standard guideline.Cannulas was placed through inferior vena cava and abdominal aorta,then connected to ECMO extracorporeal circulation pipes.Transaminase,circulation flow rate of portal vein and hepatic artery and arterial blood gas were monitored and recorded.The hepatic tissues were cut into sections for pathological observation by HE stain under a light microscope.Apoptosis was detected by TUNEL and apoptotic index was calculated.The liver was stored in cold UW for 2 h after the ECMO circulation,then orthotopic liver transplantation without veno-venous bypass was performed.The levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were measured in the peripheral blood for 5 days after the operation.Result With the increase of the running time of ECMO,transaminase and lactate levels were decreased continuously.Circulation flow rate of portal vein and hepatic artery in ECMO 6-h group was significantly lower than that in the other two groups (P＜0.05).Pathological change in ECMO 4-h group was milder than the rest two groups.Apoptosis index in ECMO 2-h,4-h and 6-h groups was (40.20 ± 7.22)％,(18.60 ± 4.04)％ and (29.25 ± 5.98) ％,respectively.The 5-day suvival rate in ECMO 2-h,4-h and 6-h groups was 83％,100％ and 83％,respectively.The transaminase level in ECMO 4-h group at 5th day after the operation was lower than in ECMO 2-h group and 6-h group (P＜0.05).Conclusion The optimal time of ECMO on repairing Maastricht Ⅱ liver was 4 h.The effect of restoration is not ideal when circulation time is not enough.Liver function and liver cell viability decline beyond 4 h.
