Decrease in core liver temperature with 10° by in situ hypothermic perfusion under total hepatic vascular exclusion reduces liver ischemia and reperfusion injury during partial hepatectomy in pigs
Decrease in core liver temperature with 10° by in situ hypothermic perfusion under total hepatic vascular exclusion reduces liver ischemia and reperfusion injury during partial hepatectomy in pigs
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DOI：
10.1016/s0039-6060(03)00125-9
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发表时间：
2003-11-01
期刊：
影响因子：
3.8
通讯作者：
van Gulik, TM
中科院分区：
文献类型：
--
作者：
Heijnen, BHM;Straatsburg, IH;van Gulik, TM
客观的。我们试图在缺血期间通过原位低温灌注使核心肝温度轻微降低10℃来评估肝脏缺血/再灌注损伤。方法。通过总肝血管在猪中诱导肝脏缺血。排除同时原位灌注低温（4℃）林格葡萄糖（冷灌注组，肝核心温度维持在28℃）、常温（38℃）林格葡萄糖（温灌注组）或不进行原位灌注（对照组）。结果。冷灌注组、温灌注组和对照组的 24 小时存活率分别为 515、015 和 315。冷灌注组的血流动力学参数保持稳定，而其他组的猪则需要循环支持。冷灌注组的血浆 AST 和白细胞介素 6 水平低于其他两组。再灌注期间胆汁产生完全恢复并且吲哚菁绿清除能力没有损失表明冷灌注组的肝细胞功能保存得最好。在其他两组中，胆汁产生和吲哚菁绿清除能力均显着降低。冷灌注组和对照组猪的透明质酸摄取能力没有差异，表明窦状内皮细胞功能得以保留。与其他组相比，冷灌注组再灌注期间的组织病理学损伤评分显着较低。结论。缺血期间原位低温肝脏灌注可将核心肝脏温度轻度降低 10°C，从而保护肝脏免受缺血/再灌注损伤。这种保护似乎与肝脏的冷却有关，而不是与灌注过程中血液的冲刷有关。
Objective. We attempted to assess liver ischemia/reperfusion injury under a mild decrease in core liver temperature of 10degreesC by in situ hypothermic perfusion during ischemia.Methods. Liver ischemia was induced in pigs by total hepatic vascular. exclusion with concomitant in situ perfusion with hypothermic (4degreesC) Ringer-glucose (cold perfused group, core liver temperature maintained at 28degreesC), with normothermic (38degreesC) Ringer-glucose (warm perfused group) or without in situ perfusion (control group).Results. In the cold perfused, warm perfused, and control groups, 24-hour survival was 515, 015, and 315, respectively. Hemodynamic parameters in the cold perfused group remained stable, whereas pigs in both other groups required circulatory support. Plasma AST and interleukin-6 levels were lower in the cold perfused group than in both other groups. Hepatocellular function was best preserved in the cold perfused group as indicated by complete recovery of bile production during reperfusion and no loss of indocyanine green clearance capacity. In both other groups, bile production and indocyanine green clearance capacity were reduced significantly. The hyaluronic acid uptake capacity of pigs in the cold perfused group or control group did not differ, indicating preserved sinusoidal endothelial cell function. Histopathologic injury scores during reperfusion were significantly lower in the cold perfused group when compared to both other groups.Conclusions. A mild decrease in core liver temperature of 10degreesC by in situ hypothermic liver perfusion during ischemia protects the liver from ischemia/reperfusion injury. This protection appears to be related to cooling of the liver rather than to the washout of blood during perfusion.