López Santamaria M, Gamez M, Murcia J, Paz Cruz J A, Bueno J, Canser E, Qi B, Lobato R, Martinez L, Jara P, Tovar J A
Department of Pediatric Surgery, Hospital Infantil La Paz, Madrid, Spain.
Eur J Pediatr Surg. 1997 Oct;7(5):270-4. doi: 10.1055/s-2008-1071169.
The hemodynamic disturbances produced by total hepatic vascular exclusion (THVE) for 40 minutes were studied in 7 pigs (19-22 kg). THVE was produced by clamping the hepatic pedicle and inferior vena cava, above and below the liver, for a 40-minutes period, followed by unclamping. Compared to baseline values, 30 minutes after onset of THVE, there was a decrease in cardiac output (3.86 +/- 0.55 vs 1.23 +/- 0.23 L x min-1), systemic arterial pressure (97.54 +/- 13.58 vs 43.43 +/- 11.38 mm Hg), and pulmonary artery pressure (16.57 +/- 6.38 vs 12.57 +/- 3.58) and an increase in systemic and pulmonary vascular resistance (1772 +/- 198 vs 2351 +/- 462, and 182 +/- 66 vs 361 +/- 124 dyn x s x cm-5 respectively). As a result of diminished cardiac output, the systemic oxygen supply decreased (461 +/- 131 vs 101 +/- 46 ml x min-1), but the systemic oxygen extraction rate rose from 17.3% t0 31.2%. Thirty minutes after unclamping, the changes had reversed and all the parameters tended to normalize. Total hepatic blood flow 30 minutes after unclamping was higher than at baseline (5.08 +/- 1.2 vs 6.66 +/- 0.67 ml x min-1 x 100 g-1), because of the increase in portal blood flow (4.52 +/- 1.21 vs 6.07 +/- 0.70 ml x min-1 x 100 g-1). There were no significant differences in hepatic oxygen supply and uptake at baseline and after unclamping (152.6 +/- 23.0 vs 187.0 +/- 34.7 and 22.7 +/- 4.9 vs 28.7 +/- 8.4 ml O2 respectively). AST rose (29 +/- 7 vs 136 +/- 91 U/l), but there was no change in the remaining liver enzymes, glucose, creatinine and serum electrolytes, so we conclude that the hemodynamic disturbances produced by 40 minutes of THVE are manageable and spontaneously reversible. Liver metabolism was not greatly disturbed, so THVE was judged to be a viable technique to be added to the surgeon's range of options.
对7头体重19 - 22千克的猪进行研究，观察完全肝血管阻断（THVE）40分钟所产生的血流动力学紊乱情况。通过钳夹肝脏上下的肝蒂和下腔静脉40分钟来实现THVE，之后松开钳夹。与基线值相比，THVE开始30分钟后，心输出量下降（3.86±0.55对1.23±0.23升/分钟），体动脉压下降（97.54±13.58对43.43±11.38毫米汞柱），肺动脉压下降（16.57±6.38对12.57±3.58），体循环和肺循环血管阻力增加（分别为1772±198对2351±462，以及182±66对361±124达因·秒·厘米⁻⁵）。由于心输出量减少，体循环氧供下降（461±131对101±46毫升/分钟），但体循环氧摄取率从17.3%升至31.2%。松开钳夹30分钟后，这些变化逆转，所有参数趋于正常。松开钳夹30分钟后的肝总血流量高于基线水平（5.08±1.2对6.66±0.67毫升/分钟·100克⁻¹），这是因为门静脉血流量增加（4.52±1.21对6.07±0.70毫升/分钟·100克⁻¹）。基线时和松开钳夹后肝脏的氧供和氧摄取量无显著差异（分别为152.6±23.0对187.0±34.7，以及22.7±4.9对28.7±8.4毫升氧气）。谷草转氨酶升高（29±7对136±91国际单位/升），但其余肝酶、血糖、肌酐和血清电解质无变化，因此我们得出结论，40分钟的THVE所产生的血流动力学紊乱是可控的且可自发逆转。肝脏代谢未受到严重干扰，所以THVE被认为是一种可行的技术，可纳入外科医生的选择范围。
