供体腹主动脉行肝动脉重建对猪肝移植血流动力学和心肌肌钙蛋白Ⅰ的影响

肝动脉重建是肝移植手术的重点和难点，其重建方式复杂多样，肝动脉重建成功与否对肝功能的恢复至关重要。近年来，为了降低移植后肝动脉栓塞的发生率，有学者采用以供体腹主动脉重建肝动脉的手术方式[1-3]，其特点是在新肝期重建肝动脉时需要阻断或部分阻断腹主动脉，但这是否会加重血流动力学变化和心肌的损害，目前尚不明确。本研究采用猪原位背驮式肝移植的动物模型，观察以供体腹主动脉重建肝动脉对受体血流动力学和心肌

供体腹主动脉行肝动脉重建对猪肝移植血流动力学和心肌

肌钙蛋白I的影响

黄国勇1，黄小彬1，刘天奇2，李静1，黄中华1，梁宁1（广西壮族自治区人民医院：1.麻醉科；2.肝胆

外科，广西南宁530021）

【摘要】目的观察以供体腹主动脉重建肝动脉对受体血流动力学和心肌肌钙蛋白I（cTnI）的影响。方法将健

康广西巴马小型猪12头随机分为供、受体两组，每组6头，受体再随机分为A组（肝动脉吻合组）和B组（腹主动脉吻合

组）），每组3头。供、受体动物均接受静脉全身麻醉，气管插管后行机械通气。供体动物行快速肝脏切取术取出供肝。受体

动物置入Swan-Ganz导管，行背驮式肝移植术，A、B组采用不同的肝动脉重建方式，A组在不阻断腹主动脉下采用肝动脉

端端连续吻合，B组在阻断腹主动脉后以其腹主动脉侧壁和供肝腹主动脉行端侧吻合。检测开腹前5min（T0）、无肝期30

min（T1）、新肝期30min（T2）、肝动脉重建后10min（T3）、术毕时（T4）、术后1h（T5）6个时间点的平均动脉压（MAP）、心率

（HR）、中心静脉压（CVP）、肺动脉压（PAP）、肺动脉楔压（PCWP）、心排量（CO）等血流动力学参数和cTnI。结果在T0~T2

时，组间各指标无差别；在T3时点，B组HR、CO低于A组，MAP、CVP、PAP、PCWP高于A组，cTnI组间无差别；在T4、T5

时，B组MAP低于A组，CVP、PAP、PCWP、cTnI高于A组，HR、CO组间无差别。结论采用完全阻断腹主动脉和以腹主

动脉行端侧吻合的肝动脉重建方式加重了血流动力学的变化和心肌损伤。

【关键词】肝移植；血流动力学；肌钙蛋白I；主动脉，腹；肝动脉/外科学；心肌/病理学；猪

文章编号：1009-5519（2012）16-2404-04中图法分类号：R657.3文献标识码：A

Effects of hepatic artery reconstructionon by donor abdominal aorta on hemodynamics and cardiac troponin-I during

pig liver transplantation Huang Guoyong1，Huang Xiaobin1，Liu Tianqi2，Li Jing1，Huang Zhonghua1，Liang Ning1（1.Depart-

ment of Anesthesia；2.Department of Hepatobiliary Surgery，People′s Hospital of Guangxi Zhuang Autonomous Region，Nanning，

Guangxi530021，China）

【Abstract】Objective To observe the effects of hepatic artery reconstruction by donor abdominal aorta on recipient hemodynamics and cardiac troponin I（cTnI）during pig liver transplantation.Methods12healthy Bama mini-pigs of Guangxi

were randomly divided into he donor group（n=6）and the recipient group（n=6）.The recipient group was randomly redivided into

the group A（hepatic artery anastomosis group，n=3）and the group B（abdominal aortic anastomosis group，n=3）.All animals ac-

cepted endotracheal intubation and intraveneous general anesthesia.The donors accepted rapid liver resection，while the recipients

accepted classic piggyback liver transplantation after Swan-Ganz catheters were inserted.Hepatic artery reconstruction of group B

was different from group A：group A accepted end-to-end anastomosis between hepatic artery of donor and recipient without oc-

cluding recipient′s abdominal aorta，and the group B accepted end-to-side anastomosis between abdominal aorta of donor and re-

cipient while occluding recipient's abdominal aorta.The hemodynamic parameters such as mean arterial pressure（MAP），heart

rate（HR），central venous pressure（CVP），pulmonary arterial pressure（PAP），pulmonary artery wedge pressure（PAWP），cardiac

output（CO）and cTnI were detected at six time points:preoperative5min（T0），30min of anhepatic phase（T1），30min of hepato-reperfusion phase（T2），10min after hepatic artery reconstruction（T3），end of operation（T4）and postoperative1h（T5）.Results

There were no differences between the group A and B in cTnI and hemodynamic parameters at time points T0，T1and T2（P＞0.05）.

HR and CO of the group B were lower than those of the group A at T3（P＜0.05），while MAP，CVP，PAP and PCWP of the group B

were higher than those of the group A（P＜0.05），and there were no differences between groups in cTnI（P＞0.05）.MAP of the group

B was lower than that of the group A at T4and T5（P＜0.05），while CVP，PAP，PCWP and cTnI of the group B were higher than those

of the group A（P＜0.05），and there were no differences between groups in HR and CO（P＞0.05）.In the trend graph of the hemody-

namic parameters changing at time points，the curve fluctuation of the group B was greater than that of the group A.Conclusion

The use of donor′s abdominal aorta for hepatic artery reconstruction by end-to-side anastomosis while occluding recipient′s ab-

dominal aorta aggravates the hemodynamics fluctuation and myocardial injury.

【Key words】Liver transplantation；Hemodynamics；Troponin I；Aorta，abdominal；Hepatic artery/surgery；

Myocardium/pathology；Swine

·论著·

基金项目：广西自然科学基金资助项目（桂科回0731010、桂科回

0639011）；广西卫生厅自筹课题（Z2007156、Z2007150）。

通讯作者：梁宁（E-mail：ln918@）。