Millis J M, Melinek J, Csete M, Imagawa D K, Olthoff K M, Neelankanta G, Braunfeld M Y, Sopher M J, Chan S M, Pregler J L, Yersiz H, Busuttil A A, Shackleton C R, Shaked A, Busuttil R W
Department of Anesthesia, UCLA School of Medicine, Los Angeles, California 90024, USA.
Transplantation. 1997 Feb 15;63(3):397-403. doi: 10.1097/00007890-199702150-00012.
To determine the impact of different flush and reperfusion techniques on postreperfusion syndrome (PRS) and postoperative graft function, 100 transplants were randomly assigned into four groups as follows: group 1 (n=31), portal vein flush, no vena caval venting; group 2 (n=21), hepatic arterial flush, no vena caval venting; group 3 (n=29), portal vein flush with vena caval venting; and group 4 (n=19), hepatic artery flush with vena caval venting. Donor and recipient characteristics were similar. Extensive intraoperative and postoperative monitoring was performed and measurements were documented immediately before reperfusion and at 1, 5, 15, and 30 min after reperfusion. PRS was defined by three criteria: mean arterial pressure (MAP) <60 mmHg at 1 min after reperfusion, MAP <60 mmHg at 5 min after reperfusion, and a decrease of 30% or more for the MAP percent area under the curve during the initial 5 min after reperfusion (%AUC). Using these definitions, the overall incidence of PRS was 21%, 8%, and 43%, respectively. Group 1 was the most hemodynamically stable; the incidence of PRS in group 1 was 2/31 (7%) at 1 min and 8/31 (25%) using %AUC criteria compared with 7/21 (33%) at 1 min and 12/21 (57%) using %AUC criteria for group 2 (P<0.05). The patients in groups 3 and 4 (vena caval venting) demonstrated smaller percentage increases in serum potassium levels (as determined by %AUC; 4.3+/-6.8 and 0.3+/-5.4, vs. 15.1+/-8.1 for group 1 and 22.9+/-8.2 for group 2). The difference between group 4 and group 2 was statistically significant (P<0.05). The increases in serum potassium did not translate into increased cardiac or hemodynamic instability. Combining all data obtained over the first 30 min after reperfusion, there was no statistically significant difference in hemodynamic or biochemical changes noted among the four groups. Postoperative liver function was similar among the four groups. We conclude that portal vein flush without vena caval venting provided a lower incidence of PRS than any other technique. Vena caval venting decreased the release of potassium into the circulation. Postoperative graft function was not significantly affected by flush and reperfusion techniques.
为确定不同的冲洗和再灌注技术对再灌注后综合征（PRS）及术后移植物功能的影响，100例移植患者被随机分为以下四组：第1组（n = 31），门静脉冲洗，无腔静脉排气；第2组（n = 21），肝动脉冲洗，无腔静脉排气；第3组（n = 29），门静脉冲洗并腔静脉排气；第4组（n = 19），肝动脉冲洗并腔静脉排气。供体和受体特征相似。进行了广泛的术中及术后监测，并在再灌注前以及再灌注后1、5、15和30分钟记录测量值。PRS由以下三个标准定义：再灌注后1分钟平均动脉压（MAP）<60 mmHg，再灌注后5分钟MAP<60 mmHg，以及再灌注后最初5分钟内MAP曲线下面积百分比（%AUC）下降30%或更多。根据这些定义，PRS的总体发生率分别为21%、8%和43%。第1组血流动力学最稳定；第1组中，根据1分钟标准PRS发生率为2/31（7%），根据%AUC标准为8/31（25%），而第2组根据1分钟标准为7/21（33%），根据%AUC标准为12/21（57%）（P<0.05）。第3组和第4组（腔静脉排气）患者血清钾水平的升高百分比更小（根据%AUC测定；分别为4.3±6.8和0.3±5.4，而第1组为15.1±8.1，第2组为22.9±8.2）。第4组和第2组之间的差异具有统计学意义（P<0.05）。血清钾的升高并未转化为心脏或血流动力学不稳定。综合再灌注后最初30分钟内获得的所有数据，四组之间在血流动力学或生化变化方面未发现统计学上的显著差异。四组术后肝功能相似。我们得出结论，不进行腔静脉排气的门静脉冲洗比其他任何技术导致的PRS发生率更低。腔静脉排气减少了钾释放到循环中。冲洗和再灌注技术对术后移植物功能没有显著影响。
