Study on metabolism and microcirculation of the liver during isolated liver perfusion in weanling swine.

本研究旨在探讨自动血泵双旁路离体肝灌注过程中机体和肝脏代谢的变化。在12只体重为3.7 ~ 6.5 kg的幼犬和9只体重为7.4 ~ 12.7 kg的断奶约克郡猪中，以10 ~ 30 ml/min/kg的流速建立肝静脉和门静脉分流的离体肝脏灌注，持续4小时。体内不含葡萄糖输注组出现明显低血糖，5%葡萄糖输注组出现明显高血糖。1.2%葡萄糖溶液组血糖稳定在500 mg/dl。肝脏中，以30 ml/min/kg流速灌注组血糖水平逐渐升高，10、20 ml/min/kg灌注组血糖水平下降。总蛋白、白蛋白和总胆固醇随时间逐渐降低。肝脏中，特别是以30 ml/min/kg流速灌注组，它们也有所减少。将猪分为4组；第1组为不含葡萄糖的灌注液灌注肝，第2组为2.5%葡萄糖溶液灌注肝，第3组为不含葡萄糖但含胰岛素的灌注液，第4组为含2.5%葡萄糖和胰岛素的灌注肝。随着时间的延长，总蛋白和白蛋白逐渐降低。含糖灌注液灌注组的下降程度较轻。灌注含糖灌注液组血糖逐渐升高。胰岛素不影响血糖水平。总胆固醇随时间逐渐降低，而甘油三酯在灌注过程中保持不变或增加。在所有实验中，胰岛素在孤立灌注时未影响肝脏代谢。

The present study was designed to investigate the metabolic changes in the body and the liver during isolated liver perfusion with double bypass using automatic blood pumps. Isolated liver perfusion was established with bypass between the hepatic vein and portal vein in 12 puppies weighing 3.7 to 6.5 kg and in 9 weanling Yorkshire swine weighing 7.4 to 12.7 kg, at a flow rate of 10 to 30 ml/min/kg for up to 4 hours. In the body, marked hypoglycemia was developed in the group with infusion without containing glucose and marked hyperglycemia in the group infused with 5% glucose solution. Blood glucose was stable at a level of 500 mg/dl in the group infused with 1.2% glucose solution. In the liver, blood glucose level was gradually increased in the group with perfusion at a 30-ml/min/kg flow rate, but blood glucose level was decreased in groups with 10-and 20-ml/min/kg perfusion. Total protein, albumin, and total cholesterol were gradually decreased with time in the body. They were also decreased in the liver, especially in the group perfused at a flow rate of 30 ml/min/kg.Then swine were divided in 4 groups ; group 1, liver perfusion with perfusate without glucose, group 2, with perfusate with 2.5% glucose solution, group 3 with perfusate not containing glucose but containing insulin, groups 4, with perfused containing 2.5% glucose and insulin. As a results, total protein and albumin were gradually decreased with time. The degree of decrease was mild in groups perfused with glucose-containing perfusate. Blood glucose was gradually increased in groups perfused with perfusate containing glucose. Insulin did not affect the glucose level. Total cholesterol was gradually decreased with time, however, triglyceride was kept constant or rather increased during perfusion. In all experiments, insulin did never influence the hepatic metabolism during isolated perfusion.