门静脉淤血对肠源性内毒素血症及肝脏缺血再灌注损伤的影响  

The effect of portal blood stasis on intestinal endotoxemia and hepatic ischemia reperfusion injury in a rabbit model

作　　者：王野[1] 杨甲梅[1] 胡明华[1] 李殿启[1] 谢峰[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝移植科,上海200438

出　　处：《中华普通外科杂志》2008年第2期81-84,共4页Chinese Journal of General Surgery

摘　　要：目的探讨门静脉淤血对肠源性内毒素血症及肝脏缺血再灌注损伤的影响。方法检测家兔肝脏原位冷灌注30min后淤血的门静脉中内毒素含量，观察清除门静脉淤血对血清内毒素、丙氨酸转氨酶（ALT）、透明质酸（HA）、肝组织匀浆丙二醛（MDA）含量、超氧化物歧化酶（SOD）活性及肝脏组织学改变的影响。结果门静脉阻断30min后，每去除2．5ml淤血可使血清内毒素含量显著下降（F=52．698，P〈0．01），但去除7．5ml后淤血中内毒素含量不再明显下降（F=1．243，P〉0．05）。去除门静脉淤血能降低复流后血清内毒素、ALT、HA和肝组织匀浆中MDA，SOD含量，改善肝脏病理学变化。其中，去除门静脉淤血在5ml与10ml时效果最为明显，与不去除相比较差异有统计学意义（F=4．835，P〈0．05）；去除门静脉淤血2．5ml、15ml时与不去除相比较差异无统计学意义（F=2．275，P〉0．05）。结论首批放出的5ml门静脉淤血中内毒素含量极高，可能是引起肝脏损伤的主要原因；放掉门静脉淤血可以减轻肠源性内毒素血症和肝脏缺血再灌注损伤。Objective To investigate the effect of portal blood stasis removal on intestinal endotoxemia and hepatic ischemia reperfusion injury. Methods A rabbit liver ischemia reperfusion injury model was established by in situ hypothermic irrigation for 30 minutes. Rabbits were then grouped by an order of 2. 5 ml removal of portal blood stasis before the portal blood circulation was resumed. Serum endotoxin content, alanine aminotransferase （ ALT）, hyaluronic acid （ HA）, content of malondialdehyde （MDA） , activity of superoxide dismutase （SOD） and liver pathology were examined. Results Compared to no removal of the portal blood stasis, the level of serum endotoxin significantly decreased with each 2. 5 ml blood removal （ F = 52. 698, P 〈 0. 01 ）, subsequently reaching the minimum at the 7. 5 ml blood removal （ F = 1. 243, P 〉 0. 05 ）. Removing portal congested blood stasis also ameliorated hepatic ischemia reperfusion injury as shown by ALT, HA as well as the amount of MDA, SOD in liver tissues and the pathology. 5 ml and 10 ml blood removal had the maximal favourable effect （F =4. 835,P 〈0. 05）, while the effect of 2. 5 ml or 15 ml blood removal was not significant （ F = 2. 275, P 〉 0. 05 ）. Conclusion The first 5 ml portal blood stasis contains high volume of endotoxin which may be responsible for intestinal endotoxemia and hepatic reperfusion injury. Removal of portal blood stasis blood before the resume of splanchnic circulation may ameliorate hepatic ischemia reperfusion injury.

关 键 词：内毒素血症 再灌注损伤 肝 门静脉淤血 

分 类 号：R686[医药卫生—骨科学]