不同水平腹内压对猪血流动力学和氧代谢指标的影响  

Effects of Different Levels of Intra-Abdominal Pressure on Hemodynamics and Oxygen Metabolism in Pig

作　　者：王大庆[1] 葛颖[1] 龚宗炼[1] 万勇[1] 

机构地区：[1]川北医学院附属医院ICU,四川南充637000

出　　处：《中国普外基础与临床杂志》2008年第5期333-336,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省教育厅重点项目(编号:2004A075)~~

摘　　要：目的观察不同水平腹内压(IAP)对猪血流动力学和氧代谢的影响,以寻找反映腹内高压(IAH)早期血流动力学和氧代谢变化的指标。方法15只猪经麻醉后,行气管插管、股动脉插管及经颈内静脉肺动脉插管,CO2充气建立气腹,根据随机数字表法将猪分为IAP10cm H2O组(IAP10组)、IAP20组及IAP30组(每组5只),记录充气前,充气后6、12、18及24h的血流动力学和氧代谢指标,观察不同水平IAP在不同时点上对血流动力学及氧代谢的影响。结果IAP10组充气后各时相血流动力学和氧代谢指标无明显变化(P>0.05);IAP20组于充气24h后出现动脉血乳酸值(ABL)明显升高(P<0.01)和混合静脉血氧饱合度(SvO2)明显下降(P<0.05);IAP30组于充气18h后即出现HR明显升高,于24h出现所有血流动力学和氧代谢指标的明显改变(P<0.05,P<0.01)。在充气24h的观察时间内,IAP30组的2只动物死亡,其余动物均存活。结论20cmH2O的IAP即会使猪的早期氧代谢指标发生变化,持续24h的高水平IAP可出现血流动力学和氧代谢指标的全面恶化,甚至导致死亡。临床上对这些指标的监测,尤其是SvO2和ABL,可较早地反映IAH对机体组织氧合状态的影响。Objective To study the effects of different levels of intra-abdominal pressure （IAP） on hemodynamics and oxygen metabolism in pig and to find the parameters early reflecting hemodynamics and oxygen metabolism of intra-abdominal hypertension （IAH）. Methods Fifteen pigs were anaesthetized, and trachea intubation and transfemoral cannula were performed then. Swan-Ganz catheters were inserted to pulmonary artery via internal jugular vein, and aeroperitoneum was set up by airing CO2. These pigs were randomly divided into three groups （5 pigs in each group） according to different levels of IAP （IAP10, IAP20, IAP30）. Hemodynamics and oxygen metabolism values were observed and recorded before airing, 6, There was no remarkable changes of hemodynamics and 12, 18 and 24 hours after airing, respectively. Results oxygen metabolism values in IAP10 group （P〉 0. 05） When the IAP level reached 20 cm H2O, there was significant elevation （P〈0.01） in artery blood lacticacid （ABL）, and mixed venous oxygen saturation （SvOz） decreased significantly （P〈0.05） at 24 hours. When the IAP level reached 30 cm H2O, HR began to increase significantly at 18 hours after airing （P〈0.05）. After 24 hours, all the indices of hemodynamics and oxygen metabolism were either significantly increased or decreased in IAP30 group. Two pigs in the group of IAP30 died during 24 hours after airing, while other pigs survived. Conclusion This study demonstrates that the hemodynamics and oxygen metabolism values begin to change in pigs when the lAP level reaches 20 cm H2O, and high level of IAP that lasted for 24 hours shows deterioration of hemodynamic and oxygenation levels. The indices of SvO2 and ABL can early reflect tissue oxygenation in IAH.

关 键 词：腹内压 血流动力学 氧代谢 

分 类 号：R656[医药卫生—外科学]