• 作者： 劉耀基; 謝介平; 何善台; 張鵬; 鄒順生; 劉思源
• 作者服務機構： 國防醫學院外科學科暨三軍總醫院外科部; 國防醫學院麻醉學科暨三軍總醫院麻醉部; 國防醫學院藥學系
• 中文摘要： 肝臟移植時之無肝期，在大量輸血後由檸檬酸鹽造成之離子性低血鈣症，與心臟血管功能關係之全部過程及無肝期時嚴重離子性低血鈣症之氯化鈣治療，尚未被探討過。 我們以肝切除及靜脈分流幫浦輔助之三組豬（18-30公斤），施予血袋之檸檬酸鹽溶液以每分鐘每公斤體重0.35毫升輸注，並測定基礎及系列之鈣、鉀、鈉離子濃度、動脈血氣體分析、溫度及心臟血管功能。第一組13隻豬接受擰檬酸鹽溶液直至心跳停止。第二組7隻豬及第三組7隻豬分別於平均動脈壓降至50至40毫米水根柱左右，停止輸注，並接受每公斤體重20毫克之氯化鈣靜脈注射，然後在1，4，8，12分鐘抽血測定以上各參數及同時測定其心臟血管功能。 當肝切除及靜脈分流幫浦輔後，心搏出量降低30 %。當[Ca]高於0.7mM時心臟血管功能無明顯之變化。當[Ca] 在0 34-0.7mM之間，[Ca] 與心捕出量，全身血管阻力及平均動脈壓間有線性關係。當[Ca] 低於0.34mM時心臟血管功能急劇降低而心臟停止跳動於[Ca] 為0 26±0.06mM時。當平均動脈壓為50±4，[Ca] 為0.3610.06mM時，大部份之心臟血管功能可經由氯化鈣給予而回復，但平均動脈壓為40±2，[Ca] 為0.33±0.05mM時，心藏血管功能無法單以氯化鈣給予而回復。
• 英文摘要： Baseline and serial values of serum [Ca], [K],[Na], arterial blood gas tensions, acid-base status,temperature and hemodynamic functions were measured during infusion of citrate-phosphate-dextrose（CPD)solution (0.35 ml.kg .min) in anhepatic pigs of three randomized groups. Thirteen pigs (group Ⅰ) con-tinued to received intravenous infusion of CPD solution until cardiac arrest. When mean arterial pressure(MAP) decreased to about 50 mmHg (group II, n＝7), or 40 mmHg (group III, n＝7) infusion of CPDsolution was discontinued, and pigs received CaCl (20 mg/kg) intravenously. Serial (1,4, 8, and 12 minafter CaCl administration) values of all the above variables and serum citrate at baseline and lowest[Ca]were measured. After hepatectomy and venovenous bypass, cardiac output (CO) decreased 30%．When ionic hy-pocalcemia was above 0.7 mM, there was no significant change of cardiovascular functions. When [Ca]was between 0.34-0.7 mM, there were linear relationships between [Ca] and CO, systemic vascular resistance(SVR) and MAP, respectively. When [Ca] was below 0.34 mM, cardiovascular functions decreasedabruptly, and the pigs died at [Ca] of 0.26±0.06 mM. When [Ca] decreased to 0.36±0.06 mMand MAP to 50±4 mmHg, most hemodynamic functions could be reversed by calcium therapy. However,when [Ca] decreased to 0.33±0.05 mM and MAP to 40±2 mmHg, hemodynamic functions couldnot be reversed by calcium therapy alone.
• 中文關鍵字： anhepatic; citrate; hypocalcemia; calcium chloride.
• 英文關鍵字： --