无心跳供体中供肝微循环的动态变化

目的 探讨不同热缺血时间下大鼠无心跳供体肝组织微循环的变化规律，预测供肝耐受热缺血的安全时限。方法 实验动物按供肝热缺血时间分别为0、15、30、45、60min，随机分为5组。然后按各组条件分别作原位肝移植．对肝移植术后各组血清透明质酸(HA)的水平进行动态检测，以及观察肝组织微循环超微结构的动态变化。结果 在热缺血30min以内，移植肝组织复流后能逐渐恢复至正常的微循环结构和功能。热缺血45min，复流后大部分肝血窦腔可逐渐恢复通畅。但部分血窦仍充满较多的膜浆泡和血细胞积滞；热缺血45min以前各组术后3d血清HA可基本恢复。热缺血60min，复流后内皮细胞损伤不但不能恢复，且出现加重、扩大趋势。结论 供肝经受30min以内热缺血损伤，肝组织微循环的变化处在可复性阶段。45min的热缺血时间可能县供肝微循环功能耐受热缺血损伤的极限．热缺血60min以后．呈现不可逆性的微循环障碍．

Dynamical changes of microcirculation of liver graft from non-heart-beating donor in rat

Objective To investigate the changes in microcirculation of liver graft under different warm ischemia time (WIT) in rats and determine the maximum limitation of liver graft to warm ischemia.Methods According to WIT,the rats were randomized into 5 groups:WIT for 0,15,30,45,60 min respectively.The microcirculation changing index of liver graft was measured by serum hyaluronic acid (HA) and ultrastructural observation.After orthotopic liver transplantation (OLTx),the recovery change of the microcirculation of liver graft after 24,48 h and 3 days were observed.Results The change in the microcirculation of liver graft injury could gradually returned to normal structure and function after reperfusion when WIT was less than 30 min.In the group of WIT for 45 min,part of blood sinusoids were full of the cytoplasmic blebs stemming from the microvilli of hepatocytes and hemocytes accumulated there; The level of serum HA in each group within 45 min of WIT almost recovered after 3 days.After 60 min warm ischemia,the damage of the endothelia of liver graft was worsened after reperfusion.Conclusion The change in microcirculation of rat liver graft is reversible when WIT was less than 30 min; Rat liver graft can be safely subjected to warm ischemia within 30 min.The duration of 45 min of WIT may be the maximal time when the function of microcirculation of liver graft can tolerate.After 60 min of WIT,there will be irreversible disturbance of microcirculation.