Orii R, Sugawara Y, Hayashida M, Yamada Y, Kubota K, Takayama T, Harihara Y, Makuuchi M, Hanaoka K
Department of Anesthesiology, Graduate School of Medicine, University of Tokyo, Japan.
Transplantation. 2000 May 27;69(10):2124-7. doi: 10.1097/00007890-200005270-00028.
The role of changes in peri-operative blood lactate levels in recipients of living-related liver transplants has not yet been clarified.
Forty-three recipients were included in this study. Blood lactate, plasma total bilirubin, aminotransferase, body temperature, and gastric mucosal PCO2 levels were measured at six time points during surgery: just before the initiation of surgery, just after dissection of the hepatic vasculature, at the end of the anhepatic phase, and 30, 60, and 120 min after reperfusion. We calculated the rate of lactate accumulation during the pre-anhepatic and anhepatic phases and the elimination rate during reperfusion (neohepatic phase), and examined the correlation between these results and the clinical findings.
The rate of lactate elimination during the neohepatic phase was correlated with the ratio of graft weight to standard liver volume (P<0.0001). There was also a significant correlation between the rate of lactate accumulation during the pre-anhepatic phase and the preoperative total bilirubin levels (P=0.0008).
Each pre-anhepatic, anhepatic, and neohepatic phase had a characteristic blood lactate profile. The graft size strongly affected lactate levels during the early neohepatic phase.
亲属活体肝移植受者围手术期血乳酸水平变化的作用尚未阐明。
本研究纳入43例受者。在手术的六个时间点测量血乳酸、血浆总胆红素、转氨酶、体温和胃黏膜PCO2水平：手术开始前、肝血管解剖后、无肝期末以及再灌注后30、60和120分钟。我们计算了无肝前期和无肝期的乳酸积累率以及再灌注期（新肝期）的清除率，并研究了这些结果与临床发现之间的相关性。
新肝期的乳酸清除率与移植肝重量与标准肝体积之比相关（P<0.0001）。无肝前期的乳酸积累率与术前总胆红素水平之间也存在显著相关性（P=0.0008）。
每个无肝前期、无肝期和新肝期都有其特征性的血乳酸谱。移植肝大小在新肝早期对乳酸水平有强烈影响。
