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[降主动脉与下腔静脉阻断致腹部脏器选择性深度低温的实验研究]

[Experimental studies on the selective profound hypothermia of the abdominal viscera by descending aorta and inferior caval vein occlusion].

作者信息

Tenmoku S

出版信息

Nihon Geka Gakkai Zasshi. 1983 Jan;84(1):40-50.

PMID:6674763
Abstract

In the present study, an effort was made to establish the procedure for 60 minutes selective profound hypothermia below 20 degrees C of the abdominal viscera. In 6 mongrel dogs, hemodynamic changes were investigated during 60 minutes normothermic vascular exclusion of the abdominal viscera by occluding the aorta and inferior caval vein just above the diaphragm. Hemodynamic state just after the combined occlusion of these vessels was stable, but 60 minutes occlusion was followed by hypoperfusion of the cranial half of the body. In 15 mongrel dogs, the 60 minutes selective profound hypothermia below 20 degrees C of the abdominal viscera was performed after occluding these vessels with an aid of extracorporeal circuit. Pooled blood in the splanchnic region during hypothermia was warmed and drained to jugular vein to maintain the hemodynamic state in the cranial half of the body. Twelve of 15 dogs survived 2 weeks after the procedure with minimal hepatic damage. In 7 mongrel dogs, blood coagulation system was investigated. Decrease of platelet, fibrinogen, plasminogen, anti-thrombin III, prothrombin and cold insoluble globulin concentration, elongation of prothrombin time and partial thromboplastin time, and elevation of FDP occurred during and after the selective profound hypothermia. But these changes were self limiting and recovered soon after heparin neutralization. In 9 mongrel dogs, extended pancreatectomy with splenectomy and combined resection of portal vein using selective profound hypothermia was performed. Bleeding and splanchnic congestion during extended pancreatectomy was minimum. Five of 9 dogs survived 2 weeks with slight hepatic and renal damage.

摘要

在本研究中,我们尝试建立一种程序,使腹腔脏器能在60分钟内选择性地降至20℃以下进行深度低温处理。在6只杂种犬中,通过在膈上阻断主动脉和下腔静脉,研究了腹腔脏器常温下血管阻断60分钟期间的血流动力学变化。这些血管联合阻断后即刻的血流动力学状态是稳定的,但阻断60分钟后出现了身体上半部分的灌注不足。在15只杂种犬中,借助体外循环阻断这些血管后,对腹腔脏器进行了60分钟、20℃以下的选择性深度低温处理。低温期间内脏区域的积血被加温并引流至颈静脉,以维持身体上半部分的血流动力学状态。15只犬中有12只在手术后存活了2周,肝脏损伤最小。在7只杂种犬中,研究了血液凝固系统。在选择性深度低温处理期间及之后,血小板、纤维蛋白原、纤溶酶原、抗凝血酶III、凝血酶原和冷不溶性球蛋白浓度降低,凝血酶原时间和部分凝血活酶时间延长,纤维蛋白降解产物升高。但这些变化是自限性的,肝素中和后很快恢复。在9只杂种犬中,采用选择性深度低温进行了扩大胰切除术加脾切除术及门静脉联合切除术。扩大胰切除术中的出血和内脏充血最少。9只犬中有5只存活了2周,有轻微的肝和肾损伤。

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