Abstract:

Objective To summarize the experience of split-orthotopic liver transplantation model in swineswithout veno-venous bypass. Methods A total number of 40 Bama mini-swines were used in this study, whichwere randomly divided into donor group and recipient group, with 20 swines in each group. 20 cases of split-orthotopicliver transplantation without veno-venous bypass were performed under general anesthesia. Arterial blood gas analysis and hemodynamic parameters were measured. The influence of the management during operations was also discussed. Results Eighteen of the recipients were successfully extubated and awake 1-2 hours postoperations. Allswines can eat and drink normally on the second post-operative day. Three of them died on the third post-operative day because of abdominal infection. The survival rate of 5 days past operation was 65%. Compared with pre-anhepaticphase，the mean arterial pressure and central venous pressure were significantly decreased and the heart rate wassignificantly increase in anhepatic phase〔mean arterial pressure（mmHg）：58.5±8.2 vs. 105.3±10.0，central venous pressure（cmH2O）：2.17±2.11 vs. 5.51±4.06，heart rate（times/min）：151.3±16.0 vs. 121.9±8.8，allP ＜ 0.05〕. Compared with anhepatic phase，pH value was significantly decreased，K+ and the concentration of lacticacid were significantly increased in hepato-repepusion〔pH ：7.307±0.083 vs. 7.514±0.071，K+ concentration （mmol/L）：5.86±0.71 vs. 3.36±0.28，lactic acid（mmol/L）：6.53±1.54 vs. 3.39±1.03，all P ＜ 0.05〕. Conclusion Hemodynamic and arterial blood gas analysis changes significantly during split-orthotopic livertransplantation in swines. By using moderate vasoactive substances, to maintain the hemodynamic parameters stability in the anhepatic phase and the short anhepatic phase are important to perform successful split-orthotopic livertransplantation.

摘要：

目的 总结无静脉转流条件下猪劈离式原位肝移植模型建立的经验。方法 选取 40 只巴马小型猪，随机分为供受体各 20 只，通过建立无静脉转流条件下猪劈离式原位肝移植模型，观察术中血流动力学及血气分析变化，探讨围手术期相关处理对模型建立的影响。结果 20 只无静脉转流条件下猪劈离式原位肝移植受体中，18 只巴马小型猪于术后 1 ～ 2 小时顺利脱机拔管并于当天麻醉清醒，术后第 2 天正常进食水，3 只受体猪术后第 3 天因腹腔感染死亡，术后 5 天存活率为 65%。与无肝期前相比，无肝期受体猪的平均动脉压、中心静脉压明显降低，心率明显增快〔平均动脉压（mmHg）：58.5±8.2 比 105.3±10.0，中心静脉压（cmH2O）：2.17±2.11 比 5.51±4.06，心率（次 / 分）：151.3±16.0 比 121.9±8.8，均 P ＜ 0.05〕。与无肝期相比，新肝期时 pH 值显著下降，K+ 浓度和乳酸浓度显著升高〔pH：7.307±0.083 比 7.514±0.071，K+ 浓度（mmol/L）：5.86±0.71 比 3.36±0.28，乳酸浓度（mmol/L）：6.53±1.54 比 3.39±1.03，均 P ＜ 0.05〕结论 猪劈离式原位肝移植术中血流动力学和血气分析结果波动大，应通过无肝期快速补液、适量给予血管活性药物以维持血流动力学稳定，并尽量缩短无肝期时间，有助于劈离式肝移植手术的成功。