体外循环对猪肠系膜微循环的影响  

The effects of cardiopulmonary bypass on porcine mesenteric microcirculation

作　　者：刘扬 徐东 LIU Yang;XU Dong(Department of Cardiovascular Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院心脏大血管外科,100050

出　　处：《心肺血管病杂志》2024年第5期517-522,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:建立中华小型猪的体外循环(cardiopulmonary bypass,CPB)模型,观察CPB对猪肠系膜微循环的影响。方法:将健康中华小型猪18只,随机分为实验组和对照组(A,B)两组;静脉麻醉后由颈静脉注入5%伊文氏蓝0.1mL/kg;采用正中开胸,升主动脉及右心房插管建立体外循环模型;静脉麻醉后心脏插管,A组接体外循环机并行循环2h,在转机前及转机30 min,60 min,120 min时用BI-2000医学系统分别测算和记录上述二组动物的肠系膜微动脉管径及血流速度,记录转机前及转机120 min时血液中WBC、RBC及血小板含量;采取部分肠系膜组织于光镜下观察其病理改变。结果:A组的微动脉管径在CPB前,转机开始后30min,60min,120min分别为(267.1±10.1)、(225.0±5.1)、(183.5±5.9)/(×10^(-5)/m)及(151.7±5.1)/(×10^(-5)/m),随体外循环时间延长,管径逐渐减小,差异有统计学意义(P<0.05),且除CPB前外,其他各时间点的微动脉管径均明显小于B组(P<0.05)。A组的微动脉流速在CPB前,转机开始后30min,60min,120min分别为(20.8±0.6)、(18.7±0.4)、(15.6±0.5)/(×10^(-4) m/s)及(13.7±0.4)/(×10^(-4) m/s),随体外循环时间延长,流速逐渐减小(P<0.05),且除CPB前外,其他各时间点的微动脉流速均明显小于B组(P<0.05);A组的OD值为(4.4±0.7)×10^(-3),B组的OD值为(2.3±0.6)×10^(-3),A组的毛细血管通透性明显高于B组(P<0.05);A组在转机120min时血液中的RBC、WBC及PLT分别为(30.8±0.9)、(154.9±10.5)、(2062.7±150.4)/(×10^(8)/L),其中RBC及PLT的数量明显低于B组,而WBC数量则高于B组(P<0.05);实验组动物的肠系膜组织在光镜下较对照组有明显的病理学改变,表现为血细胞凝集及附壁现象。结论:体外循环可引起中华小型猪明显的肠系膜微循环损伤。Objective:TEstablishing the model of the Chinese miniature pigs during cardiopulmonary bypass(CPB),and to observe the effects of cardiopulmonary bypass on porcine mesenteric microcirculation.Methods:A total of 18 healthy Chinese miniature pigs were separated into A,B two groups randomly,9 pigs were served as trials and another 9 pigs were served as controls.The two groups were both injected 5%azo-blue 0.1ml/kg into jugular veins after the intravenous anesthesia.All pigs were operated by midsternal thoracotomy,and establish the model of cardiopulmonary bypass by ascending aorta and right atrium intubations.The A,B two groups were both operated by cardiac intubations after the intravenous anesthesia.A group was connected with the CPB machine and circulated two hours.The diameters and velocities of the mesenteric arterioles of the two groups were calculated and recorded by BI-2000 at the point of CPB 30min,CPB 60min and CPB 120min.The blood visible components(WBC,RBC and PLTs)of the two groups were recorded before CPB and at the point of CPB 120min.The pathological changes of the partial mesentery tissues were also observed under the light microscope.Results:The diameters of the arterioles in the experimental group were(267.1±10.1),(225.0±5.1),(183.5±5.9)/(×10^(-5)/m),(151.7±5.1)/(×10^(-5)/m)at the point of before CPB,CPB 30min,CPB 60min and CPB 120min.With the prolongation of CPB,the diameters of the arterioles gradually decreased,and the difference was statistically significant(P<0.05),and except for before CPB,the diameters of the arterioles at all other time points in the experimental group were significantly smaller than that of the control group(P<0.05).The blood flow velocities of the arterioles in the experimental group were(20.8±0.6),(18.7±0.4),(15.6±0.5)/(×10^(-4) m/s),(13.7±0.4)/(×10^(-4) m/s),at the point of before CPB,CPB 30min,CPB 60min and CPB 120min.With the prolongation of CPB,the blood flow velocities of the arterioles gradually decreased,and the difference was statistically significant

关 键 词：体外循环 肠系膜微循环 微循环损伤 

分 类 号：R54[医药卫生—心血管疾病]