실험견에서 간동맥과 문맥의 결찰 및 재관류 시 소량의 Nitroglycerin이 혈역학 및 국소 간 관류에 미치는 영향

Abstract

Background: To reduce massive blood loss during a hepatectomy，many anesthesiologists have used the technique of low central venous pressure maintenance by administration of low dose nitroglycerin (NTG) and/or intravenous fluid reduction. However，so far there have been no studies about local liver perfusion (LLP) changes after hepatic artery (HA) or portal vein (PV) reperfusion in patients receiving nitroglycerin administration. In this study，the changes in hemodynamics and LLP following HA and PV reperfusion along with low dose (2]ig/kg/min) NTG administration in dogs were observed. Methods: A total of 20 mongrel dogs were divided into four groups; HA occlusion and reperfusion group (H，n = 5)，NTG administration group during the reperfusion on H (H-NTG，n = 5)，PV occlusion and reperfusion group (P，n = 5)，NTG administration group during the reperfusion on P (P-NTG，n = 5). After femoral and pulmonary arterial catheterization，a midline abdominal incision was made. HA and PV were exposed to clamp and declamp. A thermal diffusion microprobe was inserted in the liver parenchyme to measure LLP. Results: The PV blood flow was not changed after HA occlusion，but HA blood flow increased after PV occlusion. The LLP decreased after HA and PV occlusion. The LLP recovered to the baseline level in group H-NTG after HA reperfusion， but the LLP was more increased compared to the baseline level in group H. In group P，the LLP did not recover after PV reperfusion，but the LLP in group P-NTG recovered to the baseline level after PV reprefusion. Conclusions: In conclusion, it was observed that the LLP recovered to the baseline level by administration of NPG after PV reperfusion. However, the LLP did not increase after HA reperfusion by administration of low dose NTG. (Korean J Anesthesiol 2002; 43: 763~773)