N g h i e n ciiu Y hpc Y Hpc TP. Ho Chi Minh * Tap 20 * So 4 * 2016
KET QUA NGHIEN Cl/U M O T S6 PHl/ONG PHAP RLTA TANG M 6 I TREN THLfC NGHIEM
Do Xudn Hai*, Tririh Cao Mirdi*, Nguyin Thi Thjnh**
TOMTAT
M^c tieu: Ddnh gid mdt sdkei qud ciia md hinh ky ihuat truyen riea lay da tgng theo phucmg phdp hoa loans mdu vd ddnh gid mgt so'/cet qud hai ky thuat truyen rua trong ghep tim zm ghep tim phdi.
Bdi tWMg ^« phuang phdp nghien cdwNghiin cieu dugc tiin hanh trin 40 Ign vd 120 chuot nhat trang, phdu thugt thuc nghiem truyen riea l&y da tqng trin km vd Idy tim trin chudt.
Kii qud:Truyin riea Idy da tqng theo phucmg phdp hoa loang mdu tim mqch tucmg doi dn dinh, thdn nhiet gidm theo th&i gian (gidm 5-C sau 2h truyen riea). Cdc tgng lay sau truyen riea du. dieu kien ghep Id 100%. K^
qud truyin riea tim theo phuang phdp truyen riea qua tinh mqdi tim d&p Igi sau ghep dgt 86,7% vd th&i gian tim d&p sau ghep dqt 72ft chiim 86%>.
Kei ludtu Truyen riea da tgng theo phuang phdp hda loang mdu kei qud tqng ghep tdi han phucmg phdp truyin riea thdng thie&ng. Tim dugc truym riea qua tinh mqch chii du&i - ghep tim khac chd bu&c dau cho thm/
cd hiiu qud han truyen riea qua dgng mgch chii du&i.
Td khoa: Hoa loang mdu, lay da tqng, ghep tim ABSTRACT
RESEARCH RESULTS OF SOME NEW METHODS IN EXPERIMENTAL ABOUT MULTJ ORGANS PROCUREMENT
Do Xuan Hai, Trinh Cao Minh, Nguyen Thi Ihirh
* Y Hoc TP. Ho Chi Minh * VoL 20 - No 4 - 2016:98 -102 Objective: Review some of the results cf technical model multi-organ procurement by homodilution and results of two conventioruil methods in cardiac transplantation and cardiopulmonary transplantation.
Methods: The study was conducted on ^ pigs and 120 mice, experimental surgery taken multiple organ procurement in pigs and takm heart in mice.
Results: the results of technical model multi-organ procurement by homodilution: Relatively stable hemodynamic, reduced body temperature aver time (5^C reduction after wash 2 hours transmission); multi organs procurement can meet the standard far transplantation is 100%. The results of results of heart transmission by inferior vena cava: heart beating again after transplantation 86.7% and time after transplantation heart beats at 72 hours 86%.
Conclusiom multi-organ procuremmt technical model homodilution is better by conventional methods.
Heart transplantation is transmitted through the inferior vma cava better through the inferior vma cava.
Key words: Multi organs procuremmt, Hemodilution, Heart transplant
DAT VAN DE S^ep than, ghep gan, ghep tim, ghep tuy - thgn...da mang Igi hy vpng va cai ttiign chat Voi han 30 nam phat tri^n, nganh ghep j ^ . ^ ^^^^ ^ho nhiing benh nhan tdn tgng Viet nam eo buoe tien ro ret, ehiing ta da
• Hoc vien Quan y ** Cao dang y t^ Ha Npi
Tdc gid bin lac: BS. Do Xuan Hai DT: 0982765325 Email: [email protected]
Y Hoc TP. Hb Chi M i n h * Tap 20 * So 4 * 2016 Nghien cmi Y hpc
thuong tang 6 giai doan mu6n. Tuy vgy, thanh cong do con khiem tdn so voi thuc te doi hoi, so benh nhan suy than can ghep 6 nuoc ta la 8000, hang nam 12 tnmg tam ghep tgng ehi ghep dupe khoang 100 ca, nhu eau ghep ttiy fheo nghien ciiu chiem 5% so benh nhan mac dai thio duong^*', chi tinh rieng vien tim quoc gia hang nam co tren 4000 benh nhan nhap vien CO chi djnh ghep tim. Vi vgy nhu cau tgng gh^p la rat 16n trong khi 96% gh^p tgng nuoc ta tir nguon cho song, theo WHO so tgng lay tren nguoi cho chef nao 6 My va Chau au 3,5 tgng'^', 6 Vi^t nam so tang lay tit mpt nguoi cho chet nao hi&i tgng la 1,5 tang, nguyen nhan y hpc thuang gap la cac roi logn tim mgch va rdi logn dong m i u vi the 6 cic tang trong qui trinh lay tang hien nen can co phuong p h i p truyen n i a bao q u i n khae phuc cic nhupc diem tren. Vi vgy chiing tdi nghien ciiu de tai nay vai muc tieu: Danh gii mdt so ket q u i ciia md hinh ky thugt truyen nia lay da tang theo phuong phap hoa loang mau tren thuc nghiem; D i n h g i i mpt so ket qua hai ky thuat truyen nia trong ghep tim va ghep tim phdi tren fhijfc nghiem.
D&TUtNG-PEIUdNGPHAPNGHIENCUlJ Doi tuong nghien ciru
Nghien cdu truyen nia lay da tang theo phuang phdp hda loang mdu
Nghien ciiu thirc n g ^ e m 40 Ipn lai kinh te, cung dan, trpng lupng 30-40kg, siic khoe tdt.
Theo doi, cham soc tai phong nghien cniu th^c nghiem - Bp mon p h l u thugt thuc hanh va phau thugt thuc nghiem - Hpc vien Quin y.
Nghien cOu ky thudt truyen rda hao qudn trong ghep tim vd tim -phd'i
Nghien ciiu thuc nghiem tr&i 120 chupt cong trang, tn?ng lupng 300-400gram
Phmmg phap nghien C6TI
Nghien cihi truyen rda XKy da tang theo phuang phdp hoa loang mdu
Nghien ciiu p h l u thuat ttiuc nghiem, m6 ta.
tien ciiu. Dpng vat thuc nghi?m dupe chia ngau nhien thanh 02 nhom: Nhom 1: 20 Ian dupe truyen nia lay da tang theo phuong p h i p thdng fhuemg. Nhom 2: 20 Ion dugc truyen nia lay da tgng theo phuong phap hoa loang mau.
Npi dung dinh gii: Tmh trang toan than, tinh trang tang sau truyen nia.
Nghien aim ky thudt truyen ruia bdo qudn trong ghep tim vd tim ~ phai
Nghien ciiu phau thuat thuc nghiem, mo ta, tiai cuu, chupt thuc nghi|m dupe ehia ngau nhien fhanh 02 nhom: Nhdm 1: Truyen rua tim qua ddng mgch chii duroi 30 chupt. Nhom 02:
Truyen rua tim qua tSih mgch chii duoi 30 chupt. Tim bio quin cua ei hai nhom dupe ghep theo md hinh ciia Ono va Lindsey.
Ndi dung dinh gii: Tim dgp Igi sau ghep, thoi gian tim dap sau g^ep.
KETQUA
Ket qui nghi&n cijfu truyen r&a lay da t#ng theo phuang phap hoa loang mau Mot so dac diem chung vd todn trang tdiom
nghien cdu
Ddnh gid zH th&i gian phau thu&t
Qua nghien eiiu thoi gian truyen rua lay da tgng nhom 11a: 130 ± 17,9 (ca nhanh nhat 105 phut, ea dai nhat phut 165 phiit). Nhom 2:
110 + 14,2 (ca nhanh nhat 88 phut, ea dai nhat la 133 phiit).
- Tmh trang giim than nhiet trong thoi gian truyen nia lay da tang.
Bieu dd.2: Nhiet do trung tam
Nghidn Clin Y hpc Y H p c TP. H b Chi M i n h » T | p 20 * So 4 * 2016 Chung tdi nhan thay 6 nhom 2 nhiet dp
tnmg tam giam dan. Trong khi 6 nhom 1 than Tinh trqng huyii ddng trong th&i gian phau thu&t
nhiet tuong ddi dn dinh.
80 60 40 20 0 •
••gjl—Nnom 1
30 60 90 120 150 180
i My = Mi) + l/3(lVIx-Mn) 1 Trong do;
My; Huyet ^p tmng binh Mn; Huyet ap toi thieu M v TTllVpt sin tni rta Bim dd.l: Huy^ dp
Cdc ddc dian cua tang lay
Sau truyen nia danh gii tgng tdt ve mau sac la niau trang nga, deu khdng co diem xuat huyet.
Ty le tgng tdt sau lay b nh6m 2 cao hon nhom 1.
Bdng.l: Mdu sac tqng sau truyin riea T9ng_
Tim rrlng deu 7; Trang khong deu 10,| Tring fleu 17;
Nh6m1(n=20) [ Nh6ni2(n=20r Mau sac tgng sau tmyen rua bao quan
r^ng
Phoi Gan Tiflf Than
Nh&n1(n=20) | Nh6m2(n=20) MSu s i c t^ng sau t n i y ^ n>a bao quSn Kh6ng diJ Si&i ld#n ghep 3 Trang khdng deu 3 Trang xop 8; Trang hong + nfit Tring x6p 17; Trang
xulthuyet12. hong 3 Trang 7; Trang khong 6eu 13
Tring ng^ 8; Trang hong 12 Trang ngd 24; T r ^ g khdng deu
16
Trang 17; Tr&ig khCmgd^uS Trang nga 20 Trlng ngS 40
T&n PhSi Gan TMy Th^n
3i
Tim Phdi Gan Tuy Thgn Bim do 3: Do chac tqng sau truyin riea
Nhom 2 tang sau truyen nia eo dp chac deu
> 85%, 6 nhom 1 chung ^ i nhan thay 20% sd tang deu co bieu h i | n ddng mau rii rie.
Miie dp nhe: tdn thucmg < 10%, trung binh:
Bdng 2: Gidi phau binh tuy, thdn
10-30%, ngng: >30% ^ b a o tieu cau than, ti^u dao hiy 6 vit kinh 20x. Ton ttiuong tuy, thgn sau rura o nhom I nhieu hon d nhom XL
Mlu sinh thiit
Tyy
Than
TrmicnJB SauiO^
Sau g h ^ Tnro'Ciira
Saunja Sau ghSp
)UI|>C d$ t6n thuwng Nh«
Nh6ml 3 12 11 0 16 8
Nh6m«
1 0 3 0 0 0
Tmng binh Nh6ml
1 1 16 2 1 2
Nhbmii 1 0 3 0 0 0
Nang Nhomi
0 0 5 0 0 3
Nh6ni II 0 0 0 0 0 0
HOfitLF
4
1
Y H o c TP. H o Chi M i n h * Tap 20 * So 4 * 2016 N g h i e n cmi Y hoc Ket q u a n g h i e n ciru truyen rufa b a o q u a n trong g h e p tim va t i m - p h o i
Bdng 3: Tim dgp Igj sau ghep tim khac cho (n=60) Nhom nghien cuu
NhOmI Nhom 2 Tong c6ng
Tim d|p lai sau ghep 16«0(50%) 26/30 (86,7%)
41/60 (68%)
Tim i<hdng d|p i^i sau ghSp Do bdo qudn
2 2
Do chay mdu 4 3 7
C h u a i i 9 1 10 BdngS: Thdi gian tint dap
Nhom nghidn ciiu
NhOmI Nhom 2 Tong
'fli sau ghep tim khac cho Thoi gian d^p i^i ciJa tim gh^p 1h
12 3 15
72h 3 19 22
1tudn 4 4 Tim dgp lai sau ghep la 68%, tim ghep dap lai den 72h sau ghep la 53%.
BANLUAN
Nghien cihi truyen rtra lay da tang fheo p h u a n g p h a p hoa loang m a u
Truyen nia lay da tgng la isy ttiuat da dupe md t i nam 1986 bdi Stazl, tii do d&i nay ky thugt nay dupe i p dung hau het cic trung tam ghep tang tren the gioi®, la khau dgc biet quan trong de dim bio giii tot chiic nang cua tang ghep, giam chuyen hoa va nhung ton ttiuong do thieu oxy gay ra'^'. Voi phuong p h i p truyen nia lay da tang nguoi ta khdng quan tam Aen thcd gian nay nhung quan tam Aen viee lam the nao de lam lanh rat nhanh cic tgng can lay cung vdd truyen ruaP). Cic nghien ciiu truoc dayP> thdi gian thieu mau Ignh 98 ± ISphiit, md hinh cua chiing tdi la 110 ± 14,25, ket qua nay ciing n h u bao cao ciia Benh vien Viet E>iie va cic tie gii khad'-^. Chung tdi CO so sanh hai phucmg p h i p truyen nia lay da tgng, phuang phap Stazi (nhom 1) trien khai o cac tnmg (am ghep tgng Ion can nhieu nhan lue va ttiiet bi h i | n dgi, thoi gian phlu fhuat keo dai ttiuong hay gap cic rdi loan tim mach, eo ttie anh hudng Aen cic tgng lay ma chiing ta khong fhe phat hien dupe tnrdc ghepP>. Phuang phap mod thdi gian tien hanh nhanh hem giam cic tdn ttiirong tang do roi loan vi tuan hoan tang gay ra.
Su khae biet ve thdi gian co y nghia Ion trong (hue hien ky thugt nay.
Trong md hinh lay da tang o nhdm 1 nhjp tim k h i dn dinh do su tie ddng cua cac thuoc van mgch. Trong 8 ca co rdi logn tim mgch eo 3 ea ngung tim khi dang trien khai, chung tdi phai chuy&i md hinh truyen nia nhanh qua tihh mgch eiia,. Giam than n h i | t trong truyen nia da tang la muc ti^u xuy&n suot, theo Arrhenins than co tiie chiu dimg dupe thieu m i u d 37° C khoang 1 gio, nhung neii no dupe truyen nia lam lanh xuong 4°C thi thoi gian chiu dung thieu m i u tang len tdi 12 gid'^*>. Hg nhiet dp se giup giim ehuy&i hoa, giam nhu cau cung cap oxy nang luong dudi dang adenin nucleotit va lie che cac enzym thiiy phan (phospholipase, cac enzym ciia lysosom)'*'. Nhom 2 truyen Ringerlactat 4*'C nhiet ddng trung tam giam tii 37^C xuong 32*'C, tiieo Vant Hoff nghien ciiu hogt dp eiia enzyme, 6 n g giam nhi^t dp tii 37°C xudng SS^'C hogt tinh ciia enzyme giim tii 12-14 Ian.
Danh gii true quan tgng sau truyen nia can ciiu tren mau sac tang, mat dp tgng, lupng dieh truyen va ra ve toe dp va mau sac djch sau riiaS.*). Mau sac tgng sau nia la mau trang nga d nhdm 2 cao hem d nhdm 1, dac biet tuy, ttian la 100%. Mau trang deu, mat dp chac deu chiing td rira tuong ddi sach miu, truyen bao quan tot, neu mau khdng trang deu va mgt dp kh6ng chac tang do se khdng dii dieu kien ghep. Ket qui nay ciing tucmg dong vdi cae bio eao cua tic gji khic trong nuoc va th^ gidi'^'o), j^^^t dp tgng sau truyen nia bip quan cang deu chiing to chiic nang dem nia pH tdt, tang ISy khdng hi tdn ttiuong(^'> nhat la nhiing tdn ttiuong phu te bao do hg nhiet dp.
Ket qua giii phau benh eho thay 6 nhom 2 cd ty le tgng tdn thuong vi the it han so vdi nhom 1,
Nghien cuu Y hpc Y Hpc TP. Ho Chi Minh * Tap 20 * So 4 * 2016
P<0.01. Cic tdn fhuong true quan va vi the khdng tuong dong vdi nhau va khdng tucmg ddng vdi ty le hogi tii. Chung tdi nhan thay cd su tuong dong gjiia mat dp tgng vcd ton ftiuong vi ttie va ty le hogi tii ">. Dieu do giiip cac phau thugt vien cd the du doin chiic nang sau ghep va iy le thanh cdng sau ghep.
Nghien curu truyen nia b i o quan tim qua ddng mach chu duoi hoac tihh mgch chii dudi
Nghien ciiu so sanh hai dudng truyen nia tim trong ghep tim ttiay rang, nia tim qua dudng finh mgch chu dudi (phuong phap truyen rua trong ^ e p tim phdi) ty le tim dap Igi sau ghep, thdi gjan dap sau ghep keo dai hon rd ret d nhdm truyen nia bio quan qua ddng mgch chii duoi (phuong phap truyen rira trong ghep tim).
Cd the do dudng truyen qua fiih mgch chu dudi la dudng truyen sinh li hon? va rat can fhem nhieu nghien ciiu khic. Vdi ty le fhanh cdng 68%, ket qui nghien ciiu nay tuong duong vdi cic nghien cuu khie tren ttie gidi'^.
KITLUAN
Truyen nia da tang bang phuong p h i p hoa loang mau eho thay ket qui tang ghep tot horn phucmg p h i p truyen rCta da tgng ttidng thuang.
Tim ghep duoc truyen nia qua tinh mach chii dudi - ghep tim khic chd buoc dau cho ttiay cd hieu qui hon truyen hia qua dong mgch chii dudi.
TAI UtV THAM KHAO
1 Baumgartner et al. Heart and Heart - Lung Transplantaaon.
1990.
2 Bethea B.T, David D, Yuh, John V, Conte, Baumgartner W. A.
Heart tranplantation Cardiac Surgery in die Adult Mc Graw HilL N e w York 2003
3. DKC Cooper and R P . Lanza. Heart Transplantatioa 1984.
4 C3h^ tuy tien ftivc nghiem va ^ l e p tyy tren ngiroL ESE tai c5p nha nude.
5. CJiao hinh g h e p tang. Hoc vi&i quan y, tap I v a 1 ^ 2 . 6. Joseph T. Santoso, M.D., Edward V. Hannigan, M.D. Lyuba
Levine, M.D., Daneshvan R. Solanki, M.D.and MaU Maftiru, M.D. Effect of HemodilutKm on Tissue Perfusion and Blood Coagulation during Radical Hysterectomy. 2001.
7 Michael W, Mulholland el al. Greenfield's surgery- Sdentific P n n a p l e s and Practice. 2011.
8 Niuni M., I h e technique for heterotopic cardiaoansplantatian m mice: experience of 3000 operationsby (me suigetvi, /. Hart Lung Tnm^lant, 20,1123,2001.
9 Sarah A. Hosgood, James P. Hunter and Michael L Nicholson, Cold Isdiaetnic Injury m Kidney Transplantation.
2012.
Ngdy rihdn bdi bdo: 10/11/2015 Ngdy phdn bien nhan xd bdi bdo: 26/11/2015 Ngdy bdi bdo dugc dang: 25/07/2016
