机械通气下腹腔高压对肝脏损伤影响的实验研究  

Experimental study on liver injury induced by intraperitoneal hypertension under mechanical ventilation

作　　者：张奭 王宏业 尉继伟 Zhang Shi;Wang Hongye;Yu Jiwei(Department of Tumor Surgery,the Affiliated Hospital of Shanxi Datong University,Datong 037005,Shanxi,China)

机构地区：[1]山西大同大学附属医院肿瘤外科,山西大同037005

出　　处：《中华危重病急救医学》2021年第6期740-743,共4页Chinese Critical Care Medicine

基　　金：山西省重点研发计划(指南)项目(201603D321054)。

摘　　要：目的通过制备机械通气腹腔高压动物(猪)模型,观察机械通气对腹腔间隔室综合征(ACS)动物肝脏细胞学及酶学指标的变化规律。方法选择健康成年实验猪6只,全麻后行气管插管给予呼吸机辅助通气,呼吸模式为:容量控制通气(VCV),设定潮气量(VT)10 mL/kg,呼吸频率(RR)16次/min,吸入氧浓度(FiO_(2))0.40,呼气末正压(PEEP)5 cmH_(2)O(1 cmH_(2)O=0.098 kPa)。采用水囊叠加加压法制备腹腔高压动物模型,通过向加压水囊注入生理盐水模拟腹腔增压过程,每注入50 mL生理盐水测压1次。于术前和术后4 h内每隔1 h经耳缘静脉采血5 mL,行肝脏酶学检查;4 h后处死动物取肝脏组织,光镜下观察病理学改变。结果6只猪均成功制模,动物的RR、心率(HR)均维持平稳,实验过程中无一只发生气压伤或死亡。腹腔高压动物模型中腹腔压力与腹腔增容量呈正相关关系(r^(2)=0.8396,P=0.0037)。术前和术后1、2、3、4 h各间点丙氨酸转氨酶(ALT)、碱性磷酸酶(ALP)、胆碱酯酶(ChE)水平比较差异均无统计学意义。随时间延长,天冬氨酸转氨酶(AST)呈先升高后降低趋势,术后1 h较术前明显升高(U/L:46.84±8.57比23.35±5.14,P<0.05),术后2、3、4 h均较术前明显降低(U/L:16.33±3.58、14.54±3.35、15.44±3.21比23.35±5.14,均P<0.05);γ-谷氨酰转移酶(GGT)亦呈先升高后降低趋势,但仅术后1 h较术前明显升高(U/L:101.20±17.79比51.34±9.13,P<0.05),其余各时间点与术前比较差异均无统计学意义。光镜下可见肝组织汇管区小叶间静脉扩张淤血,小叶间胆管扩张,小胆管增生;汇管区结缔组织增生,大量急慢性炎细胞浸润;肝细胞肿胀,胞质淡染,部分细胞呈气球样变,可见点状坏死。结论机械通气下腹腔高压可使肝脏出现明显的酶学改变和细胞学损害。Objective To investigate the effects of mechanical ventilation on liver cytological and enzymatic indexes in abdominal compartment syndrome(ACS)by establishing a porcine model of abdominal hypertension.Methods Six healthy adult pigs were selected.After general anesthesia,they were intubated and given ventilator assisted breathing.The breathing mode was volume controlled ventilation(VCV),tidal volume(VT)10 mL/kg,respiratory rate(RR)16 time/min,fraction of inspiration oxygen(FiO_(2))0.40,positive end expiratory pressure(PEEP)5 cmH_(2)O(1 cmH_(2)O=0.098 kPa).Intraperitoneal pressure was simulated by injecting normal saline into the pressurized water sac,and the pressure was measured once every 50 mL of normal saline.5 mL of blood was collected from ear vein every 1 hour before and 4 hours after operation for liver enzyme examination.4 hours after operation,the animals were sacrificed and the liver was collected to observe pathological changes under light microscope.Results Six pigs were successfully modeled.The RR and heart rate(HR)of the animals remained stable.No one suffered from barotrauma or death during the experiment.There was a positive correlation between abdominal pressure and abdominal volume increase(r^(2)=0.8396,P=0.0037).There were no significant differences in the levels of alanine aminotransferase(ALT),alkaline phosphatase(ALP)and cholinesterase(ChE)preoperative and 1,2,3,4 hours after operation.As time went on,aspartate aminotransferase(AST)increased first and then decreased,and increased significantly at 1 hour after operation(U/L:46.84±8.57 vs.23.35±5.14,P<0.05),and decreased significantly 2,3,4 hours after operation(U/L:16.33±3.58,14.54±3.35,15.44±3.21 vs.23.35±5.14,all P<0.05).The level ofγ-glutamyltranspeptidase(GGT)increased and then decreased,but there was significant difference only at 1 hour after operation,compared with baseline(U/L:101.20±17.79 vs.51.34±9.13,P<0.05).Under the light microscope,there were dilation and congestion of interlobular vein,dilation of interlobular bile du

关 键 词：腹腔高压 模型 动物 压力-容积曲线 肝脏 

分 类 号：R657.3[医药卫生—外科学]