Yamashita C, Wakiyama H, Okada M, Nakao K
Department of Surgery, Kobe University School of Medicine, ICAM Co., Ltd.
Kobe J Med Sci. 1998 Dec;44(5-6):199-203.
The purpose of this experiment was to evaluate the etiology of hepatic dysfunction in patients difficult to wean from cardiopulmonary bypass. We hypothesized that increased central venous pressure and subsequent hepatic congestion during weaning from cardiopulmonary bypass would lead to hepatic dysfunction. To induce hepatic congestion in mice, we clamped the hepatic vein for fifteen min, and observed the microcirculation of the liver using an intravital microscope during clamping and the following 30 min of reperfusion. During reperfusion, non-reflow phenomenon, leukocytes adhesion to the wall of sinusoids, erythrocytes sludging, acute swelling of hepatic cells and narrowing of sinusoids were observed. These phenomena were indicative of warm ischemia-reperfusion injury of the liver itself. Based on these findings we concluded that, after repeated episodes of warm ischemia and reperfusion of the liver, hepatic cells would be damaged, and finally hepatic dysfunction was induced. To prevent hepatic dysfunction, repeated attempts to wean the patient from cardiopulmonary bypass should be avoided and increases central venous pressure should be prevented by early use of cardiopulmonary support.
本实验的目的是评估体外循环后难以脱机患者肝功能障碍的病因。我们假设，体外循环脱机过程中中心静脉压升高及随后的肝脏充血会导致肝功能障碍。为在小鼠中诱导肝脏充血，我们夹闭肝静脉15分钟，并在夹闭期间及随后30分钟的再灌注过程中使用活体显微镜观察肝脏微循环。在再灌注期间，观察到无复流现象、白细胞黏附于肝血窦壁、红细胞淤滞、肝细胞急性肿胀及肝血窦狭窄。这些现象表明肝脏本身存在温缺血-再灌注损伤。基于这些发现，我们得出结论，肝脏反复经历温缺血和再灌注后，肝细胞会受损，最终导致肝功能障碍。为预防肝功能障碍，应避免反复尝试使患者脱离体外循环，并应通过早期使用体外循环支持来预防中心静脉压升高。
