Experimental Studies on Reperfusion Injury of the Liver in Dogs

本研究的目的是利用成年杂种犬，不仅阻断肝脏血流，而且阻断肝脏下腔静脉血流，以明确肝脏再灌注损伤的限度以及血液或脂质过氧化反应中前列腺素和内毒素的变化。实验模型分为3组：I组(缺血60min)、II组(缺血120min)和III组(II组+4^ﾟC林格液肝脏灌流)。在阻断肝动脉、门静脉和下腔静脉肝上下段血流时，门静脉和下腔静脉的淤血用输血泵转流到颈静脉。灌注时，在门静脉主干向肝侧插入一根肝缺血闪光导管，经股静脉将肝内液体引流至肝下腔静脉。1.…术后5天存活率组I、组II和组III的ER再通率分别为83%、14%和43%，肝功能衰竭是所有死亡的主要原因。2.各组再灌流后即刻肝功能受损，存活组于再灌后3d恢复正常，死亡组肝功能加重。与I组和III组相比，GorupII组的肝功能异常最为明显。3.血中前列腺素：6-酮-前列腺素F_1、1α-前列腺素F_1(6KF)在再灌流后即刻升高，以II组最高。6KF在I组和II组存活3小时后显著下降，而血栓素B_2(TxB_2)在存活组升高，但在死亡组在再灌注3小时后迅速下降。因此，TxB_2/6-KF在再灌流后即刻显着降低，II组预后最差。4.各组再灌流后血内毒素均升高，3h达高峰，以后有所下降，组Ⅱ恢复明显延迟。5.存活者再灌流后血中过氧化脂质含量升高，3天后恢复正常，与肝脏过氧化脂质浓度呈正相关。6.肝组织血流量在再灌流后2小时下降，存活者恢复正常。在肝窦中，Kupffer细胞肥大在7天后仍可观察到，但在14天后有所改善。这些发现为了解肝脏缺血的限度和可逆性提供了有用的信息。较少

The purpose of this study is to clarify the limit of reperfusion inJuries in the liver and the changes of prostanoid and endotoxin in the blood or lipid peroxidative reaction by interrupting not only hepatic blood inflow but also that in the hepatic inferior vena cava, using adult mongrel dogs. The experimental models were classified into 3 groups:GroupI (60-minute ischemia), GroupII (120-minute ischemia) and GroupIII (GroupII+liver perfusion with 4^ﾟC Ringer's solution). During interruption of blood flow in the hepatic artery, portal vein, and both superior and inferior hepatic portionof inferior vena cava, stasis blood in the portal vein and inferior vena cava were bypassed into the jugular vein using a blood delivery pump。 For perfusion, a catheter for ischemic liver flashing was inserted into the main portal vein toward the liver side and a catheter for drainage of fluid perfused from liver into the hepatic inferior vena cava via the femoral vein. 1. The survival rate of 5 days aft … More er reperfusion was 83% in Group I, 14% in GroupII, and 43% in GroupIII, and liver failure was the main cause of death in all non-survivors. 2。 Liver function was impared immediately after reperfusion in each group and normalized at 3days after reperfusion in the survivors but aggravated in the non-survivors. GorupII showed the most marked abnormality in liver function, comparing with Groups I andIII. 3. Prostanoid in blood : 6-keto-prostaglandin-F_<1alpha> (6KF) increased immediatelyafter reperfusion, and it showed highest value in GroupII. 6KF was decreased markedly after 3hours in the survivors of GroupI and II. On the other hand, thromboxane B_2(TxB_2 was high in the survivors but rapidly decresed 3hours after reperfusion in the non-survivors. Therefore TxB_2/6-KF was marked low value immediately after reperfusion in GroupII shown poorest prognosis. 4. Blood endotoxin increased after reperfusion in each group, reaching a peak after 3hours, but decreased thereafter ; the recovery in GroupII was significantly delayed. 5. Blood lipid peroxide was high after reperfunsion but was normalized after 3days in the survivors, being correlated with the lipid peroxide concertration in the liver. 6. Blood flow in the liver tissue decreased 2hours after reperfusion and recovered in the survivors. In sinusoids of the liver, Kupffer cell hyertrophy was observed even after 7days but improved by after 14days.These findings provide useful information on the limit and reversibility of ischemia in the liver. Less