早期持续高容量血滤对SAP猪的胰腺及胰腺外器官病理变化的影响  

Effect of early continuous high-volume hemofiltration on histopathological changes of pancreas and extrapancreatic organs in pigs with severe acute pancreatitis

作　　者：张震环[1] 李维勤[1] 王浩[1] 燕晓雯[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院外科重症监护室,江苏省南京市210002

出　　处：《世界华人消化杂志》2006年第22期2180-2185,共6页World Chinese Journal of Digestology

基　　金：江苏省社会发展基金资助项目;No.BS2000051

摘　　要：目的:观察早期持续高容量血液滤过(HVHF)对重症急性胰腺炎(SAP)猪的胰腺及胰外重要脏器病理变化的影响．方法:长白猪24只,随机分为:对照组(n=8,模型组),低容量血滤组(n=8),接受20 mL／(kg·h)置换量的血液滤过,及HVHF组(n=8),接受100 mL／(kg·h)置换量的血液滤过．通过向胰管注入40 g／L牛磺胆酸钠(1 mL／kg)和胰蛋白酶(2 U／kg)溶液,诱导猪的SAP模型．治疗组在模型诱导后立即开始血滤治疗,并观察各组的生存时间以及胰腺和胰外重要脏器的组织病理学评分．结果:各组的半数生存期分别是41,50和65 h (P<0．01)．胰腺本身的病理损害评分在各组间无明显差异(P>0．05),但HVHF组在肝细胞的变性、肺透明膜和微血栓的形成以及肾小管损伤等指标的评分上明显降低(P<0．05)．结论:持续性血液滤过虽然不能减轻SAP猪胰腺本身的病理损害,但早期HVHF能有效地减轻SAP猪肝细胞的变性、肺透明膜和微血栓的形成以及肾小管的损伤,延长生存时间．AIM： To observe the effect of early continuous high-volume hemofiltration on the histopathological changes of pancreas and extrapancreatic organs in pigs with severe acute pancreatitis （SAP）.METHODS： Twenty-four domestic pigs were randomly and averagely assigned into 3 groups： control group （untreated model group） as group A, low-volume hemofiltration [20 mL/（kg · h）] group as group B, and high-volume hemofiltration [100 mL/（kg · h）] group as group C. SAP model was produced by injection of sodium taurocholate （40 g/L, 1 mL/kg） and trypsin （2 U/kg） via the pancreatic duct. The pigs in group B and C received hemofiltration immediately after modeling. The parameters including survival time and histopathological scores of pancreas and extra-pancreatic organs were observed.RESULTS： The median survival times were 41, 50 and 65 h in group A, B, and C, respectively, and there were significant differences among them （P 〈 0.01）. The histopathological scores had no marked differences between the three groups （P 〉 0.05）. However, the scores for hepatocellular degeneration, pulmonary hyaline membranes and microthrombi, and renal tubular damage were obviously lower than those in the other groups （P 〈 0.05）.CONCLUSION： Although hemofiltration can not reduce the pancreatic damage in pigs with SAP, early continuous high-volume hemofiltration can significantly ameliorate the hepatocellular degeneration, the formation of pulmonary hyaline membranes and microthrombi, and the renal tubular damage in pigs with SAP, which is useful in improving the survival time.

关 键 词：血液滤过 急性胰腺炎 组织病理学 多器 官功能障碍综合征 

分 类 号：R576[医药卫生—消化系统]