肝移植におけるV-V bypassに関する実験的研究 ： 血行動態と移植肝の早期代謝機能監視の立場より

Abstract

The anhepatic period of orthotopic hepatic transplantation is commonly accompanied by specific cardiovascular disorders due to the occlusion of portal and inferior vena caval systems. The present study was undertaken to elucidate the effect of veno-venous bypass (v-v bypass) on hemodynamic and early metabolic function of 16 dogs with hepatic allografts under mechanical ventilation with barbiturate and muscle-relaxants. (Fio₂ : 0.21, Vт=10 ml/kg, f : 10/min.) The dogs were divided into two groups which one group has been performed with stable pressure in systolic, portal and inferior vena cava : functional v-v bypass group (n=8), and poor-functional group (n=8). The survival rate of the functional group was 75% and of the poor-functional group 38%. In comparative assessment of v-v bypass functional and poor-functional groups, the following parameters were determined : pH, Pco₂, Po₂, Base Excess (arterial, portal and inferior vena caval venous), arterial ketone body ratio (AKBR), pyruvate to lactate ratio (P/L), branched-chain to aromatic amino-acid ratio (BCAA/AAA) and hepaplastine test (HPT). These considerations suggest that the monitoring of hemodynamics and metabolic functions play important roles in successful hepatic transplantation.