间歇性脾动脉阻断在医源性脾损伤中的应用实验  

The application of intermittent splenic artery occlusion for treating iatrogenic splenic injury： an animal experiment

作　　者：李志超 朱孝成 李超 时林森 孟松 王辉 姚立彬 

机构地区：[1]徐州医科大学研究生院,江苏徐州221004 [2]徐州医科大学附属医院胃肠外科

出　　处：《中华肝胆外科杂志》2017年第1期54-57,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨间歇性犬脾动脉阻断在医源性脾损伤中的应用价值，观察其引起的缺血再灌注损伤。方法犬全麻开腹建立医源性脾损伤动物模型，按照是否阻断脾动脉分为实验组和对照组。实验组采用间歇性脾动脉阻断联合明胶海绵压迫创面止血，脾动脉阻断时间首次为15min。如仍有出血，则再依次继续阻断10min、5min，然后解除阻断及压迫观察止血效果。对照组仅明胶海绵压迫止血。两组分别于阻断／压迫前及阻断／压迫后2h取血和组织标本进行IL-1、超氧化物岐化酶（SOD）、髓过氧化物酶（MPO）、丙二醛（MDA）和天冬氨酸半胱氨酸蛋白酶（Caspase-3）检测。结果对照组止血无效，实验组均成功止血。实验组手术前后血清指标分别为IL-1（124．4±106．8比121．2±105．1），SOD（4．7±2．7比5．2±1．8），MDA（8．8±6．5比10．8±7．5）；实验组与对照组手术后分别为IL-1（121．2±105．2比162．8±73．8），SOD（5．2±1．8比4．7±2．8），MDA（10．8±7．5比9．6±6．6），其差异均无统计学意义（均P〉0．05）。组织学指标实验组止血前后分别为MPO（0．62±0．23比0．68±0．21），Caspase-3（0．90±0．29比0．86±0．26），实验组与对照组手术后分别为MPO（0．68±0．21比0．86±0．23），Caspase-3（0．86±0．26比1．21±0．18），差异均无统计学意义（均P〉0．05）。结论对于医源性脾损伤患者进行间歇性脾动脉阻断联合明胶海绵压迫止血是安全有效的，且未引起明显缺血再灌注损伤。Objective To evaluate the value of intermittent splenic artery occlusion in the treatment of iatrogenic splenic injury and the cause of ischemia reperfusion injury. Methods Experimental animals using dogs were divided into experimental group and control group according to whether the splenic artery was blocked. The animal model of iatrogenic splenic injury was established by general anesthesia. Experimental group was treated with intermittent splenic artery blockage combined with gelatin sponge oppression of the wound to stop bleeding. The first time of splenic artery occlusion was 15 min and continued for 10 min and for another 5 min if still bleeding. Then hemostatic effect after removing blocking and oppression was observed. Control group was only treated with gelatin sponge compression to stop bleeding. Blood samples and tissue samples were collected before blocking and after reperfusion for 2 hours in experimental group, and before compression and relieving the compression for 2 hours in control group. IL-1 （ interleukin）, SOD （ superoxide disproportionation enzyme）, MPO （ myeloperoxidase）, MDA （malondialdehyde） and caspase-3 （aspartame acid cysteine protease） were detected. Results The control group still had bleeding, while the experimental group had successfully stopped bleeding. Serum markers before and after occlusion in the experimental group were IL-1 （ 124.4 ± 106.8 vs. 121.2 ± 105.1 ）, SOD （4.7 ±2.7 vs. 5.2 ±1.8） and MDA （8.8 ±.5 vs 10.8 ±7.5）. There were no significant differences on serum markers in two groups after occlusion/oppression including IL-1 （ 121.2 ±105.1 vs. 162.8 ±3.8）, SOD （5.2 ± 1.8 vs. 4.7 ±1.8） and MDA （ 10.8 ±7.5 vs. 9.6 ± 6.6） （ P 〉 0.05 ）. Histological indicators before and after occlusion in the experimental group included MPO （0.62 ±0.23 vs. 0.68 ±.21 ） and Caspase-3 （0.90 ±0.29 vs. 0.86 ± 0.26）. and there was no statistical difference on MPO （0.68 ± 0.21 vs. 0.86±0 23 after two sets of experiments�

关 键 词：医源性脾损伤 间歇性脾动脉阻断 动物实验 犬 明胶海绵 

分 类 号：R657.6[医药卫生—外科学]