Study on biochemical and morphological changes in the liver and metabolism of the body and liver during isolated liver perfusion in weanling swine.

本研究旨在研究全自动血泵双旁路离体肝灌流过程中肝脏的生化和形态变化，以及肝脏的代谢变化。将15只体重为3.5~6.0 kg的杂种犬和18头体重6.8~12.2 kg的约克夏断奶仔猪，分别以10、20、30ml/min/kg的流量，建立肝静脉和门静脉分流的肝脏隔离灌流模型，持续4h。另一条体外循环将来自肠道和下半身的静脉血转流至上腔静脉。灌流液中谷丙转氨酶和乳酸浓度在各组猪肝脏灌流过程中均无变化，而幼犬肝脏在10ml/min/kg和30ml/min/kg灌流时出现缺血性改变。能源费用保持不变。光镜下，三组均保留了肝实质和汇管束结构的正常组织学结构。透射电子显微镜显示三组大鼠大部分肝细胞在2小时内未见大体结构异常。但灌流3小时以上，极少数肝细胞内可见线粒体肿胀和光滑内质网。这一现象类似于休克早期的现象。当流速为10ml/min/kg时，更多的肝细胞出现这种肿胀。部分动物的糖原颗粒随时间延长而减少。代谢分析显示，无肝期血糖在体内逐渐升高。在肝脏中，血糖在开始灌流时迅速升高，并随着时间的推移逐渐下降。总胆固醇和总蛋白在体内随时间逐渐下降，并在开始时迅速下降并维持在肝脏中。这些结果表明，隔离肝脏灌流强烈影响肝脏和全身代谢。

The present study was designed to investigate the biochemical and morphologic changes in the liver, and also metabolism during isolated liver perfusion with double bypass using automatic blood pumps. Isolated liver perfusion was established with bypass between the hepatic and portal veins in 15 mongrel dogs weighing 3.5 to 6.0 kg and in 18 weanling Yorkshire swine weighing 6.8 to 12.2 kg, at a flow rate of 10,20,30 ml/min/kg for up to 4 hours. Venous blood from the intestine and lower body was bypassed to the superior vena cava with another extracorporeal circuit. Perfusate glutamic pyruvic transaminase and lactate concentrations did not change during liver perfusion in all groups in swine, in contrast to ischemic changes at 10 ml/min/kg and congestion at 30 ml/min/kg in the liver of the puppy. Energy charge was maintained. Microscopically, normal histology of the hepatic parenchyma and portal tract structures was preserved in three groups. Transmission electron microscopy showed no gross structural abnormalities in most of the hepatocytes for up to 2 hours in three groups. However, swelling of the mitochondria and smooth endoplasmic reticulum was visualized occasionally in a very small number of the hepatocytes after more than 3 hours of perfusion. This phenomenon resembled that at the early phase of shock. This swelling was observed in more hepatocytes at a flow rate of 10 ml/min/kg. Glycogen granules decreased with time in some animals. On metabolic analysis, blood glucose gradually increased in the body at the anhepatic phase. In the liver, blood glucose rapidly increased at the commencement of perfusion and gradually decreased with time. Total cholesterol and total protein gradually decreased with time in the body, and rapidly decreased at the commencement and maintained in the liver. Those results demonstrated that the isolated liver perfusion strongly affected hepatic and general metabolism.