摘要
目的 :探讨提高小型猪胰腺十二指肠移植手术成功率的术中管理措施。方法 :4 0只小型猪随机配对行胰腺十二指肠移植 2 0次 ,用氯胺酮、速眠新基础麻醉后 ,气管插管 ,氯胺酮加依托咪酯维持麻醉。颈外静脉和颈动脉插管监测中心静脉压、平均动脉压、血气分析 ,经供体腹主动脉放血4 0 0～ 80 0mL ,术中输给受体 ,根据中心静脉压调节输液 ,开放血流时静滴地塞米松、多巴胺。结果 :手术成功率为 90 % ,受体动脉平均压在吻合血管开放后有明显下降 ,与血流开放前差异有显著性 (P <0 0 5 ) ,中心静脉压和血气指标无明显变化。经供体腹主动脉采血优于静脉 ,平均补液 81 5mLkg-1、输血 4 0 0mL及大剂量地塞米松、多巴胺有助于开放血流后受体循环的稳定。结论 :加强术中循环的监测、及时补液与输血 ,特别在开放血流后保持循环系统稳定是提高移植手术成功率的关键。
Objective:To explore and improve operative management measures of pancreaticduodenal transplantation in miniature Swine.Methods:The 40 miniature Swine were divided into donors and recipients,pancreaticduodenal transplantation was performed in 20 times.Miniature Swine were anesthetized with ketamin and maintained with ketamine and etomidate.Meanwhile,Mean Artery Pressure,Central Venous Pressure and Blood Gas were monitored.And the 400～800 mL blood was obtained from abdominal aorta of donor and transfused to recipient in the operation.Dexamethasone and dopamine were given as the reopening of inosculated blood vessels.Results:The rate of successful operation was 90%.Recipients MAP were significantly decreased after the reopening of inosculated blood vessels.There was significant difference than it before the reopening( P <0 05).Other monitored data had not change markedly.The average transfusion was 400 mL to recipients and injected dexamethasone as well as dopamine had contributed to stablization of circular system in the reopening of inosculated blood vessels.Conclusion:Enhancement of monitoring and management of circular system,transfusion and stabilization blood pressure could improve the rate of successful operation and it was crucial for pancreaticduodenal transplantation in miniature Swine,especially after the reopening of inosculated blood vessels.
