Kato T, Kano T, Nonami T, Takagi H
Department of Surgery II, Nagoya University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1990 May;91(5):605-16.
During the anhepatic phase of orthotopic liver transplantation, the veno-venous bypass has been used to keep systemic hemodynamics (SHD) in a stable condition. In this study, changes of SHD and oxygen transport and consumption (OTC) during the anhepatic phase used the passive bypass (PB) with Anthron bypass tubes were compared with those used the pump-driven bypass (PDB) with a centrifugal pump in mongrel dogs. Moreover the effects of the increased instillation rate and administration of dobutamine on SHD and OTC were evaluated. The portal venous and inferior vena caval pressure were increased in PB group, but not in PDB group. Whenever PB or PDB was used, cardiac index and oxygen consumption were markedly decreased caused by hypovolemia. In PDB group trebled the instillation rate, SHD and oxygen consumption were not improved. These results suggested that the primarily cardiovascular depression during the anhepatic phase was related to the disturbance of SHD. When dobutamine was administered and the instillation rate was trebled in PDB group, SHD and OTC were maintained in a favorable state. It is concluded that PDB, administration of dobutamine and sufficient instillation are advantageous to maintain systemic hemodynamic stability during the anhepatic phase of orthotopic liver transplantation.
在原位肝移植的无肝期，静脉 - 静脉转流术已被用于维持全身血流动力学（SHD）处于稳定状态。在本研究中，将杂种犬在无肝期使用带有蒽酮转流管的被动转流（PB）时的SHD以及氧运输和消耗（OTC）变化，与使用离心泵进行泵驱动转流（PDB）时的情况进行了比较。此外，还评估了增加灌注速率和给予多巴酚丁胺对SHD和OTC的影响。PB组门静脉和下腔静脉压力升高，而PDB组未出现这种情况。无论使用PB还是PDB，由于血容量不足，心脏指数和氧消耗均显著降低。在PDB组中，灌注速率增加两倍，SHD和氧消耗并未改善。这些结果表明，无肝期主要的心血管抑制与SHD紊乱有关。当在PDB组中给予多巴酚丁胺且灌注速率增加两倍时，SHD和OTC维持在良好状态。得出的结论是，PDB、给予多巴酚丁胺和充足的灌注有利于在原位肝移植的无肝期维持全身血流动力学稳定。
