CO_2气腹对内毒素血症猪的代谢影响  

Effects of pneumoperitoneum with carbon dioxide on metabolism in pigs with endotoxemia

作　　者：傅仲学[1] Nagelschmidt Manfred Holthausen Ulla Troidl Hans 张才全[1] 韩文妙[1] 

机构地区：[1]重庆医科大学临床学院普外科,重庆400016 [2]德国科隆大学医学院第二外科

出　　处：《重庆医科大学学报》2002年第3期260-263,共4页Journal of Chongqing Medical University

摘　　要：目的:探讨CO2气腹对内毒素血症猪代谢的影响。方法:只雄性家猪随机分为对照组;内毒素组和内毒素加二氧21化碳气腹组。实验在静吸复合麻醉下进行。组和组经静脉给予内毒素,后组用BC30minCCO2建立气腹。每监测一次各60min种指标和收集标本。气腹持续。3h结果:CO2气腹组动脉血呈显著的混合型酸中毒改变,导致了值和值显著降低apHipH(P<;0.05)CO2气腹组肠壁水平明显低于对照组和内毒素组,但无显著性差异;ATPCO2气腹对内毒素引起的α代谢变化无TNF-明显影响。结论:本研究提示在有基础生理紊乱,即使是亚临床的生理紊乱的情况下,CO2气腹可能导致严重的酸碱平衡紊乱、组织酸中毒和能量代谢紊乱。Objective: To investigate the effects of pneumoperitoneum with carbon dioxide on metabolism in pigs with endotoxemia. Methods: Twenty-one pigs randomly divided into three groups: control group(group A), endotoxin group (group B, 2μg/kg·h), endotoxin and pneumoperitoneum with CO2 group (group C, 15mmHg). The experimental period of the study was 5.5 hours ( 30 min endotoxemia, 3 hours pneumoperitoneum, 2 hours further monitor). Primary endpoints were arterial blood gas, mucosal pH of jejunum(ipH) and ATP level of jejunum wall. Statistical evaluation was performed by analysis of ANOVA Student-Newman-Keuls. Results: Endotoxin infusion can induce symptoms of an early septic shock. Two animals in group C died in 1~2 hours after pneumoperitoneum with CO2 due to serious acidosis and shock. Pneumoperitoneum with CO2 led to significant decrease of apH, ipH, aHCO3 - and aBE and significant increase of aPCO2. Endotoxin may induce significant increase of plasma TNF-α, but there was no difference between group B and group C. ATP level of jejunum wall in group C was lower than that of group A and group B, but there was no significant diffrence in all of the three groups. Conclusion: Our study suggests that pneumoperitoneum with carbon dioxide during endotoxemia can seriously damage the acid-base balance and metabolism of energy of experimental animal. We think laparoscopic operation with pneumoperitoneum with CO2 can enhance the risk of patients with sepsis.

关 键 词：气腹 二氧化碳 内毒素血症 

分 类 号：R61[医药卫生—外科学] R631.3[医药卫生—临床医学]