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相關文獻
- Peri-Anhepatic Phase Oxygen Kinetics in Porcine Liver Transplantation
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題名 | Peri-Anhepatic Phase Oxygen Kinetics in Porcine Liver Transplantation=豬肝移植中靜脈繞道術對無肝期血流及氧動力學之影響 |
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作者 | 唐高駿; 單子元; 呂學嘉; 林秉熙; 雷永耀; 陳國漢; 李德譽; 彭芳谷; Tang, Gau-jun; Shann, Tzyy-yuan; Lu, Hsueh Chia; Lin, Bing-shi; Lui, Wing-yiu; Chan, Kwok-hon; Lee, Tak-yu; P'eng, Feng-ku; |
期刊 | 中華醫學雜誌 |
出版日期 | 19990500 |
卷期 | 62:5 1999.05[民88.05] |
頁次 | 頁285-293 |
分類號 | 416.246 |
語文 | eng |
關鍵詞 | 無肝; 肝臟移植; 氧消耗量; 血氧攜行量; Anhepatic phase; Liver transplantation; Oxygen consumption; Oxygen delivery; |
中文摘要 | 背景:研究豬在肝臟移植手術中無肝期間(anhepatio phaso)血氧供氧量與 耗氧量之相關性,並進一步探討靜脈-靜脈繞道術對此期間氧動力學之影響。 方法:12隻豬隨機分為兩組:無靜脈繞道組經截斷肝動脈、門靜脈、上腔與下腔靜脈 後,產生無肝期;靜脈繞道組則於術中另行接受靜脈-靜脈繞道術。術中同時監測無肝期 前後之血流動力學、血氧攜行量指數、氧消耗量指數。 結果:無靜脈繞道組之血壓、心輸出量指數與氧消耗量指數均於血流截斷後顯著下降 ,並出現乳酸中毒;靜脈繞道組之心輸出量及血氧攜行量措數於血流截斷後雖穎著下降, 氧消耗量措數卻因代償性血氧擷取比例之增加而得以維持。血流復通後,血氧攜行量及氧 消耗量指數均顯著增加。有3種線性關係描述其相關性:血流量依賴耗氧之斜率最高為0. 232(95%CI=0.110-0.364,r□=0.50,p:O.O10);非血流量依賴耗氧之斜率趨近於零 ,且供氧量及耗氧量間無相關;病理性血流量依賴耗氧之斜率為0.185(95%CI:0.050- 0.333,r□:0.510,p=0.029)。 結論:若無靜脈繞道術,無肝期之血氧攜行量將降至臨界點以下,同時出現血流量依 賴型之氧消耗。豬行肝臟移植手術時,靜脈-靜脈繞道術為維持臨界點以上之血氧攜行量 及穩定之血流動力學所必需。無肝期後,氧動力關係轉為病理性血流量依賴型之氧消耗。 |
英文摘要 | Background. We applied a liver transplantation animal model to examine the relationship between oxygen delivery and consumption. The presence of pathologic flow-dependent oxygen consumption was investigated during and after the anhepatic phase. The effect of venous-to-venous bypass on oxygen kinetics was evaluated. Methods. Twelve pigs were randomly divided into two groups. The non-bypass group consisted of six pigs that were subjected to clamping of the hepatic artery, portal vein, and the superior and inferior vena cava to produce an anhepatic phase. The bypass group consisted of six pigs that underwent vascular clamping and liver transplantation with venous bypass. Hemodynamics, oxygen delivery index (DO□) and oxygen consumption index (VO□) were recorded during the peri-anhepatic phase. Best-fit regression lines were calculated for DO□ vs VO□. Results. In the pigs without venous bypass, the blood pressure, cardiac index and VO□ dropped significantly after vascular clamping and lactic acidosis developed. In pigs with venous bypass, vascular clamping induced a significant decline of cardiac output and D0□ but VO□ was maintained by a compensatory increase in oxygen extraction ratio. D0□ and VO□ after the release of vascular clamping increased significantly higher than that before vascular clamping. The 0□ supply-dependent regression line was drawn from the points below critical oxygen delivery with a slope of 0.232 (95% CI = 0.110- 0.354, r□ = 0.50, p = 0.010). The pathologic supply-dependent line was drawn from the points with supranormal D□ and V□ with a slope of 0.185 ( 95% CI = 0.050-0.333, r□ = 0.510, p = 0.029). The slope of the supply- independent line was 0.0089 (95% CI = -0.030-0.050, r□ < 0.009, p = 0.12). Conclusions. Oxygen delivery dropped below the critical level and flow- dependent oxygen consumption developed during the anhepatic phase without venous bypass. Venous-to-venous bypass is necessary to maintain a critical DO 2and stable hemodynamics during porcine liver transplantation. Pathologic flow-dependent oxygen consumption developed after the anhepatic phase. |
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