The Study Of The Impact Of Cardiac Arrest To The Donor Liver Quality

Part I Rat cardiac arrest model establishment and observationObjective: To establish a rat model simulated clinical cardiac arrest resuscitation after reperfusion injury rat model of cardiac arrestMethod: Through the clip the abdomen aorta for 5min and open,to simulate clinical DCD for have appeared cardiac arrest and recovery before donation.Clipping abdominal aorta to make the circulation stop below the chest, and then remove bulldog clamp cause liver ischemia-reperfusion injury.Establish the control group without clipped the abdomen aorta at the same time, to explore the cardiac arrest and arrest effect on rat liver hemodynamics.Results: The experimental group measure MAP、Pa O2 and Pa CO2 in the following point in time:before clip the abdominal aorta,clipped 0min、cliped 2min、cliped 4min、open 0min、open 5min.MAP: 18.5±1.2k Pa、0±0 k Pa 、 0±0 k Pa 、 0±0 k Pa 、 17.9±1.1 k Pa 、 18.0±1.0 k Pa;Pa O2:129.0.±7.05 mm Hg 、 130.08±5.86 mm Hg 、 20.44±2.65 mm Hg 、 9.96±2.42 mm Hg 、 46.41±1.76 mm Hg 、 129.92±6.98 mm Hg;Pa CO2 :41.51±4.18 mm Hg、40.89±2.75 mm Hg、69.89±3.13 mm Hg、83.65±3.04 mm Hg、78.43±2.94 mm Hg、43.89±3.78 mm Hg.The Control Group MAP: 18.6±0.9 k Pa、18.5±1.4 k Pa 、18.1±1.0 k Pa、18.3±1.1 k Pa、18.8±0.7 k Pa、18.7±1.1 k Pa;Pa O2:129.97±7.41 mm Hg、125.82±6.09 mm Hg 、 129.80±6.53 mm Hg 、 131.73±6.89 mm Hg 、130.54±6.86 mm Hg、128.32±6.23 mm Hg;Pa CO2:42.89±2.06 mm Hg、43.20±2.05 mm Hg、42.75±2.51 mm Hg、41.37±2.36 mm Hg、41.89±3.4 mm Hg、41.59±4.03 mm Hg. After clipped the arterial blood pressure of the experimental rats immediately drop to 0 ± 0 k Pa, 18.5 ±1.4 k Pa significantly lower than the control group(P < 0.05). After remove the bulldog clamp the arterial pressure of the experimental group returned to normal 17.9 ± 1.1 k Pa, 18.8 ±0.7 k Pa without difference with controlgroup(P > 0.05). Pa O2 gradually reduced after the clipped, After remove the bulldog clamp 5mins the Pa O2 of the experimental group was 129.92± 6.98 mm Hg, and the control group was 128.32±6.23 mm Hg(P > 0.05),After clipped the Pa CO2 of the experimental group escalate.After remove the bulldog clamp 5mins and the Pa CO2 of the experimental group resume normal 43.89 ±3.78 mm Hg and 41.59 ±4.03 mm Hg no difference with the control(P > 0.05).Conclusion : The model of rat cardiac arrest is stable, reliable and repeatability.Part II: Different reperfusion time after cardiac arrest resuscitation in the rat liver quality evaluationObjective: To assess the quality of the DCD liver of rats in different reperfusion time after cardiac arrest resuscitation.Methods: According to the different reperfusion time, On the basis of the experimental model of cardiac arrest。The rats divide into group A: 0hreperfusion、group B: 1h-reperfusion、group C:3h-reperfusion、group D: reperfusion group E:9h-reperfusion、group F:12h-reperfusion、group G: 24 h-reperfusion. Operation with the improved method of Kamada DCD liver transplantation model in liver transplantation.Pathological examination of each group of liver tissue before transplantation.Measure Alt before transplantation、1、 3、 5 and 7 days after transplantation; And calculate the survival between groups after transplantation in rats.Results: 1.After clipped the abdominal aorta,the ALT of GROUP D come to the peak,127.7±29.0U/L,later decrease. The ALT of Group E、Group F、Goup G is 78.3±9.3 U/L、63.3±4.9 U/L、57.2±6.3 U/L,The ALT of Group A、Group B、Goup C、Group G is 50.8±6.5 U/L、49.2±7.2 U/L、62.7±8.8 U/L、57.2±6.3 U/L Compared with normal group 46.0 ± 5.5 U/L show no statistical difference(P>0.05)Pathology showed, Group A showed only central venous congestion; B group showed neutrophil infiltration, into nests; Group C showed expansion of hepatic sinus; Group D showed liver cells appeared serious ballooning, hepatic sinus expansion at the sametime, the central venous congestion; Group E showed cell edema,and compared with group D was reduce;The proportion of the group F cell edema further reduce than group E, Group G cells showed no difference with normal liver tissue. 2. The ALT in 1, 3, 5, and 7 days after transplantation are: Group A(436.1±73.3 U/L、460.9±81.8 U/L、175.2±37.1 U/L、71.9±16.7 U/L)、Group B(443.4±93.8 U/L、429.8±81.7 U/L、174.2±49.0、81.8±20.8 U/L)、Group C( 581.1±227.1 U/L、565.6±232.6 U/L、227.2±109.2 U/L、101.1±42.7 U/L)、Group D(1683.3±390.9 U/L、1680.9±261.5 U/L、1114.7±208.9 U/L、474.6±112.9 U/L)、Group E(996.7±213.9 U/L、722.0±162.9 U/L 、 561.5±114.1 U/L 、 246.2±56.0 U/L)、 Group F(961.0±295.9 U/L、721.9±200.0 U/L、288.5±56.4 U/L、121.4±30.1 U/L)Group G(436.1±73.3 U/L、485.1±81.0 U/L、205.8±65.9 U/L、77.2±21.3 U/L). 1, 3, 5, and 7 days survival rates are Group A(100%、100%、100%、100%)、Group B(100%、100%、100%、90%)、Group C(100%、90%、90%、90%)、Group D(50%、40%、40%、40%)、Group E(80%、70%、70%、70%)、Group F(90%、90%、90%、90%)、Group G(100%、100%、100%、100%).No difference in ALT between Group A、B、C、G.The ALT of Group D、E、F are higher than other Group(P<0.05)。The ALT of Group D is highest and dfferent with Group E、F.The ALT of Group F show no statistical difference with Group E in 1、3 day after liver transplant and have difference in 5and 7 day. Group F thehigher survival rate than group E. A, B, C, F, G group of rat survival rate among comparison there was no significant difference. D, E group rat survival rate decline, compared with the other groups was statistically difference. Group D was lower than those of group E postoperative survival rate, the difference was statistically significantConclusions: 1.Cardiac arrest and resuscitation for 6 hours, the ischemia-reperfusion injury reach peak,and prompt inappropriate for the liver at this time. 2.The ischemia-reperfusion damage of liver gradually reduce after cardiac arrest and resuscitation from 6 hours to 24 hours.