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

本研究旨在探讨全自动血泵双旁路离体肝灌流过程中机体和肝脏的代谢变化。将12只体重3.7~6.5 kg的幼犬和9头体重7.4~12.7 kg的约克夏断奶仔猪，在肝静脉和门静脉之间建立隔离肝脏灌流，流量为10~30ml/min/kg，持续4h。在体内，不含葡萄糖输液组出现明显低血糖，而输注5%葡萄糖液组出现明显高血糖。输注1.2%葡萄糖溶液组的血糖稳定在500 mg/dl水平。肝脏中，30ml/min/kg灌注组血糖水平逐渐升高，10ml/min/kg和20ml/min/kg灌注组血糖水平下降。体内总蛋白、白蛋白、总胆固醇随时间逐渐降低。然后将猪分为4组，第1组肝脏灌流不含葡萄糖，第2组灌流2.5%葡萄糖溶液，第3组灌流不含葡萄糖但含有胰岛素的灌流液，第4组灌流2.5%葡萄糖和胰岛素。结果表明，随着时间的延长，总蛋白和白蛋白逐渐降低。含葡萄糖灌流液灌注组的下降程度较轻。灌流组大鼠血糖逐渐升高。胰岛素不影响血糖水平。随着时间的推移，总胆固醇逐渐降低，但甘油三酯在灌流过程中保持不变或升高。在所有实验中，胰岛素在隔离灌流过程中从未影响肝脏代谢。

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.