门静脉淤血对肝脏缺血再灌注后肺脏和肾脏损伤的影响  

The effect of portal blood stasis on lung and renal injury induced by hepatic ischemia reperfusion in a rabbit model

作　　者：王野[1] 杨甲梅[1] 侯元凯[1] 李殿启[1] 胡明华[1] 刘鹏[1] 

机构地区：[1]第二军医大学东方肝胆外科医院,上海200438

出　　处：《中华外科杂志》2008年第8期602-605,共4页Chinese Journal of Surgery

摘　　要：目的探讨门静脉淤血对肝脏缺血再灌注后肺脏和肾脏损伤的影响及机制。方法对24只新西兰大白兔行肝门阻断，同时经门静脉肝脏原位冷灌注30min，恢复灌流时按门静脉淤血去除量的不同随机分为3组：A，组去除5ml、A10组去除10rml、B组不去除门静脉淤血，每组8只。另取8只作为对照（C组），仅行手术解剖，不做肝门阻断及肝脏灌注。检测去除门静脉淤血对恢复灌流4h后血清内毒素、肿瘤坏死因子-α（TNF-α）、尿素氮（BUN）、肌酐（Cr）的影响；取肺脏、肾脏组织观察组织学改变并检测组织匀浆丙二醛（MDA）、超氧化物歧化酶（SOD）及肺湿／干重、肺灌洗液蛋白含量的变化。结果去除门静脉淤血能降低复流后血清内毒素、TNF-α、BUN、Cr、肺湿／干重、肺灌洗液蛋白含量和肺脏、肾脏组织匀浆中MDA含量。其中A，组血清TNF-α、Cr、肺灌洗液蛋白含量、肾组织匀浆中MDA均明显低于B组（P〈0．05）；A10组血清内毒素、TNF-α、肺湿／干重及肺组织匀浆中MDA也明显低于B组（P〈0．05）。去除门静脉淤血可增加肺脏、肾脏组织匀浆中SOD活性，其中气组肾组织匀浆中SOD活性明显高于B组（P〈0．05）。同时，去除门静脉淤血能明显改善肺脏、肾脏组织学变化。结论去除门静脉淤血可以减轻肝脏缺血再灌注后肺脏、肾脏功能的损伤，其机制可能与门静脉淤血去除减少内毒素吸收，进而降低了血清TNF-α产生有关。Objective To investigate the effect and mechanism of portal blood stasis on lung and renal injury induced by hepatic ischemia reperfusion. Methods A rabbit hepatic ischemia reperfusion injury model was established by hepatic portal occlusion and in situ hypothermic irrigation for 30 min. Twenty-four New Zealand white rabbits were employed and randomly divided into 3 groups equally by different dosage of portal blood stasis removal： group A5 （5 ml blood removal）, group A10 （10 ml blood removal） ,and group B （ no blood removal）. Eight rabbits were served as controls with no hepatic portal occlusion and hypothermic irrigation. After reperfusion 4 h serum endotoxin content, tumor necrosis factor-u （ TNF-α）, urea nitrogen （ BUN）, and creatinine （Cr） were examined respectively, meantime lung and kidney tissues were sampled to determine the content of malondialdehyde （ MDA）, superoxide dismutase （SOD） ,the pathology, and wet to dry weight ratio, broncho-alveolar lavage fluid protein content in lung tissues. Results Removing portal blood stasis ameliorated lung and renal injury as shown by decreasing the level of serum endotoxin,TNF-α, BUN, Cr, wet to dry weight ratio, broncho-alveolar lavage fluid protein content, MDA, SOD. TNF-α,Cr, broncho-alveolar lavage fluid protein content in lung tissues and MDA in kidney tissue in group A5 were significantly reduced compared with those in group B（ P 〈0.05 ） ,while in lung tissue in group A10 were also markedly reduced （P 〈 0. 05）. The activation of SOD in group A5 were significantly increased （P 〈 0. 05 ）. Conclusions Removal of portal blood stasis before the resume of splanchnic circulation may ameliorate the lung and renal injury induced by hepatic ischemia reperfusion. The possible mechanism may be that portal blood stasis removal reduces endotoxin absorption, and further decreases production of serum TNF-α.

关 键 词：再灌注损伤 内毒素类 肿瘤坏死因子α 肺损伤 肾损伤 

分 类 号：R686[医药卫生—骨科学]