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개의 동소성 간 이식술시 이식 간의 재관류시에 관찰되는 혈행 동태에 관한 연구
황성환,오상훈,백계형,김상효 인제대학교 1996 仁濟醫學 Vol.17 No.2
본 연구의 목적은 개의 동소성 간이식 모델에서 혈역학적 변화를 정확히 측정하여 임상에서 많은 문제를 일으키는 이식간의 재관류 후에 발생하는 혈역학적 변화 양상을 좀 더 정확히 밝혀 보려는 데 있다. Biopump에 의한 정-정맥 우회술을 이용하여 개에서 동소성 간이식을 시행하였으며, 재관류 전(III-5)과 후(III+5)의 혈역학 지수의 평균치 변화를 비교하였다. 10례 중 4례에서 재관류 후 증후군이 나타나 종래의 방법에 의한 개의 간이식 실험에서보다 적은 빈도를 보였으며 간의 허혈 방지와 수술 수기의 향상과 전신 대사 이상의 적극적인 치료 등 종래보다 발전된 간이식으로 재관류 후의 혈행 동태를 안정화시킬 수 있었고, 재관류 후에 페동맥 고혈압은 거의 나타나지 않아 재관류 후에 나타나는 폐혈관 저항의 증가 양상은 재관류 후 증후군의 한 현상이 아닌 별개의 현상으로 생각된다. Objective: To study the hemodynamic changes after reperfusion during orthotopic liver transplantation(OLT). Methods and Materials: During OLT, hemodynamic changes after reperfusion were studdid in 10 mongrel dogs. And then hemodynamic variables at each stage of operation were measured and compared with the stage of 5-minutes before reperfusion and 5 minutes after reperfusion. Results: The mean value of mean arterial pressure was decreased from 90±9.5mmHg to 74.3±27.0 mmHg(p=0.13). In four of ten cases, mean arterial pressure was decreased over 30% and showed post-reperfusion syndrome(PRS). The mean value of systemic vascular resistance was decreased from 3857.2±1900 dyn.sec/cm3 to 2640.4 ±769dyn.sec.cm3(p<0.05). Cardiac output was decreased in 7 cases(p=0.63). The mean value of mean pulmonary arterial pressure was decreased from 14.6±2.27 mmHg to 11.7±2.71mmHg(p<0.05), and pulmonary vascular resistance was decreased from 284.0 ±239 dyn.sec/cm3 to 255.2±199 dyn.sec/cm3(p =0.57). Pulmonary hypertension which could be seen in orthotopic liver transplantation was not noted with this study even though 4 cases showed PRS. Conclusion: Increased pulmonary vascular resistance or pulmonary arterial pressure after reperfusion could be an independent phenomenon rather than a part of PRS.
개의 동소성 간이식술에서 혼합정맥혈 산소포화도의 지속적 감시에 의한 산소운반 및 섭취능력 평가
조강희,왕희정,우성,김문철,백계형,이혁상 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.11
There are many hemodynamic and physiologic changes during liver transplantation much more than other surgical interventions. The oxygen delivery and oxygen consumption are af- fected by depressed hemodynamic and metabolic status during the operation. At the lower levels of oxygen present in venous blood, a linear relationship exists between saturation and tension. The use of fiberoptic oximetry system in conventional pulmonary artery flotation catheters has made the bedside application of this relationship of practical value in the continuous assessment of mixed venous oxygen saturation. This study was performed to determine changes in Sv ̄O₂ and other variables of oxygen kinetics during canine OLT and study the correlation between Sv ̄O₂ and cardiac output, Sv ̄O2 and oxygen consumption and oxygen utilization ratio. The continuous rnixed venous oxygen saturation and cardiac output by SO₂/CO computer were monitored and the oxygen delivery, oxygen consumption and oxygen utilization ratio were calculated by arterial and venous blood gas analysis and modified Fick's equation during orthotopic liver transplantation in 20 dogs. The results were as follow as ; 1. There was no significant difference in tissue oxygen extraction between preoperative control and anhepatic phase, while cardiac output were decreased during anhepatic phase. 2. By utilizing centrifugal pump(venovenous bypass) oxygen delivery and oxygen utilization ratio were well maintained even though suppressed the change of oxygen delivery and oxygen consumption during anhepatic phase. 3. There was a significant decrease in Sv ̄O₂ immediately after declamping the suprahepatic vena cava, whereas the oxygen utilization rate and oxygen consumption following reperfusion were significantly increased than just prior to reperfusion of transplanted liver. 4. A Statistically significant correlation was found between Sv ̄O₂ and cardiac output, oxygen consumption in all surgical stages except reperfusion(CO;r=0.478, p$lt;0.001, VO₂,r=-0. 272, p=0.004), but their correlations were relatively poor. However, there was highly significant correlation among Sv ̄O₂ and oxygen utilization ratio in all surgical stages(O₂UR; r=- 0.834, P$lt;0.001). In conclusion, continuous monitoring mixed venous oxygen via a fiberoptic pulmonary catheter could be used as the index for evaluation of hemodynamics and oxygen kinetics during canine OLT, but further research should be performed to determine whether these measurements indicate viability of the grafted liver.
간이식 수술중 혈전탄성묘사도 변수에 따른 혈액응고관리의 효과 분석
김명호,김종운,우성,이혁상,백계형,김문철,왕희정 대한마취과학회 1997 Korean Journal of Anesthesiology Vol.32 No.4
Introduction: Thromboelastography (TEG) provides an overall assessment of the platelet-coagulation protein cascade interaction. The information generated from the TEG is rapidly obtained and made useful to guide replacement therapy. The purpose of this study was to evaluate the efficacy of the TEG as its guided blood replacement therapy and pharmacological therapy during liver transplantation. Methods: This study was carried out in 13 consecutive patients who were subjected to TEG-guided replacement therapy during liver transplantation. A prepared mixture of blood products used for continuous replacement therapy was a fluid composed of red blood cells(2 units), fresh frozen plasma (2 units), and normal saline(500 ml). The pharmacological therapy was performed by comparing TEG of untreated blood and blood treated with antifibrinolytic and heparin neutralizing agent. Based on the findings of TEG, platelet concentrates were given. The TEG samples were obtained at various intervals. Additional TEG tracing was obtained as needed to see the effect of therapeutic intervention. Results: In all patients the reaction time was kept in an acceptable range in the preanhepatic stage by administration of the mixture of blood products. Heparin-induced anticoagulation was observed in 3 cases in the anhepatic stage and in 11 cases upon reperfusion. Fibrinolysis was seen in all but one patients: 8% in the preanhepatic stage, 41% in the anhepatic stage, 69% at reperfusion, and 2% in the postanhepatic stage. Early and aggressive treatment with epsilon-aminocaproic acid effectively inhibited fibrinolysis without complications. Ten patients needed platelet transfusion in the postanhepatic stage with significant improvement in the TEG. Conclusions: The results of this study suggest that TEG monitoring and TEG-guided replacement and pharmacological therapy are clinically effective in maintaining blood coagulability. (Korean J Anesthesiol 1997; 32: 604∼615)