肝移植国外论文.DOC

1. 肝移植术后早期的微透析监测与临床经验 (瑞典)哈德斯菲尔德大学医院Karolinska研究所 移植手术部 Br J Surg. 2002 Sep;89(9):1169-75 PMID: 背景 肝移植术后的实时监测变得越来越必要； 组织微透析膜技术的成熟，以及大量的动物实验检验； 方法 研究对象为10名整个器官原位肝移植患者。手术后在肝内植入微透析导管。另外在腹部缝合后，立即在右胸皮下组织植入一根参照导管。 手术后三天内连续采样，每一小时采样一次；监测项目：葡萄糖，乳酸，丙酮酸和甘油。 结果 在最初的24小时内，肝内葡萄糖水平高于参照组织内的含量。 最初，肝内乳酸的increased mean(s.e.m.)水平值为7.0(1.9)mmol/l,24小时后急速下降至2.7(0.3)mmol/l。肝移植后的24小时内，乳酸/丙酮酸比率下降并逐渐稳定，从18.7(4.2)至10.0(1.1);在导管植入并稳定采样后16小时，肝内甘油由62.3(7.4)下降至24.3(7.5)mmol/l; 总结 微透析仪可连续显示移植后肝内的新陈代谢；过程简单且安全； 对未来研究移植后，组织病理变化将有很大帮助； (例如 动脉和门静脉血栓的形成，早期急性排斥反应；) 原文： Br J Surg. 2002 Sep;89(9):1169-75. Clinical experience in continuous graft monitoring with microdialysis early after liver transplantation. Nowak G, Ungerstedt J, Wernerman J, Ungerstedt U, Ericzon BG. Source Department of Transplantation Surgery, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden. grzegorz.nowak@karo.ki.se Abstract BACKGROUND: Early detection of impaired graft function after transplantation is essential. Microdialysis permits continuous monitoring of metabolic changes by mimicking the passive function of a capillary blood vessel by perfusion of a tubular semipermeable membrane introduced into the tissue. Based on the results of animal experiments, a clinical pilot study was undertaken. METHODS: Ten consecutive patients undergoing whole-organ orthotopic liver transplantation were studied. Intrahepatic implantation of a microdialysis catheter was performed at the end of the operation. A reference catheter was placed in the subcutaneous tissue over the right pectoral area immediately after abdominal closure. Consecutive serial samples were collected at 1-h intervals for 3 days after the operation. Glucose, lactate, pyruvate and glycerol concentrations were measured. RESULTS: During the first 24 h, the glucose level was higher in the liver than in reference tissue. Initially, increased mean(s.e.m.) levels of lactate (7.0(1.9) mmol/l) were observed in the liver, with a r