高原人工肝支持系统体外血液循环的建立

摘要

目的 在高原环境下建立适用于人工肝支持系统治疗研究的大动物体外血液循环方法.方法 已适应本地环境(海拔3700m)的健康长白仔猪6只,在盐酸氯胺酮及地西泮静脉注射麻醉下,分别行颈总动脉/颈外静脉插管及经左颈外静脉至下腔静脉/右颈外静脉插管,分为相应的两组(n=3),1d后连接血路及反应器装置,采用转流速度阶梯升高的方式进行体外血液循环,观察两组实验动物一般情况、血压、心率、出血情况及最低肝素维持速度和管道凝血情况.结果 在不影响实验动物血流动力学的前提下,颈总动脉/颈外静脉插管组最高转流速度为133.33±28.87ml/min,最低肝素维持速度为138.67±12.22mg/h,动物出血倾向明显,管道凝血现象严重;经左颈外静脉至下腔静脉/右颈外静脉插管组的最高转流速度为400ml/min,最低肝素维持速度为26.67±9.24mg/h,动物无出血倾向,管道凝血现象不明显.结论 采用经左颈外静脉至下腔静脉/右颈外静脉插管、血流速度400ml/min建立的体外血液循环对高原小型猪人工肝支持系统治疗的研究较为适宜.%Objective To establish extracorporeal circulation in big animal suitable for the research on artificial liver support system in high altitude region. Methods Under the anesthesia of ketamine hydrochloride/diazepam IV, cannulation of common carotid artery/external jugular vein (n=3) and inferior vena cava via the left external jugular vein/right external jugular vein (n=3), was respectively performed on six healthy Cheng-Bai piglets adapted to native environment (altitude 3700m). One day after that, the extracorporeal circulation was performed at a progressively elevated blood current velocity, and the general condition of the animals, blood pressure, HR,bleeding tendoncy of the experimental pigs and coagulation in the cannulae were observed. Results On the premise that the hemodynamics was not influenced, the highest blood current velocity was 133. 33 ± 28. 87ml/min, the lowest heparin maintaining speed amounted to 138. 67±12.22mg/h, and the bleeding tendency and blood coagulation in the cannula was significant in the group of common carotid artery/external jugular vein imubation. While the highest blood current velocity was 400ml/min, the lowest heparin maintaining speed was 26. 67±9. 24mg/h, no bleeding tendency or obvious cannular blood coagulation were observed in the group of cannulation of inferior vena cava via the left external jugular vein/right external jugular vein. These untoward results were significantly less or slight than that of the former group (P＜0. 01). Conclusion It is suitable to perform research of artificial liver support system on piglets in high altitude region by establishing extracorporeal circulation by the way of inferior vena cava with cannulation passing through the left external jugular vein/right external jugular vein with the blood current velocity of 400ml/min.