摘要
目的 探讨肝撞击伤后腹腔镜CO2气腹状态下胃血流量的变化及胃粘膜组织病理学变化。方法 建立肝撞击伤动物模型，按从股动脉抽血量的不同（6、12ml／kg）以及CO2气腹压力的不同（5、10、15mmHg），将45只新西兰兔随机分为6组（Ⅰ～Ⅵ）。采用彩色微球法检测气腹前、气腹30分钟、气腹2小时以及撤去气腹后30分钟共4个时相点的胃血流量的变化，并在实验结束后取胃黏膜作病理检查。结果当失血达6ml／kg、CO2气腹压力达5mmHg，气腹2小时以及撤去气腹后30分钟的胃血流量较气腹前呈明显下降；当失血达6ml／kg、CO2气腹压力达10mmHg、在气腹30分钟以及气腹2小时时胃血流量呈显著下降（P〈0．05），当撤去气腹后胃血流量逐渐恢复正常。当失血量达6ml／kg和12ml／kg，CO2气腹压力在10mmHg时，虽然气腹30分钟，胃血流量无显著下降（P〉0．05），但6ml／kg组胃血流量在气腹2小时时则显著下降（P〈0．05），撤去气腹后胃血流量逐渐恢复。而当失血达6ml／kg和12ml／kg，CO2气腹压力达15mmHg时，胃血流量在气腹30分钟时即显著下降（P〈0．05）。当失血量相同，在不同的CO2气腹压力下，胃血流量在气腹30分钟时均无显著差别（P〉0．05）。本组胃组织病理学显示，胃缺血后胃黏膜间质呈现明显水肿，并伴有大量炎性细胞浸润。结论肝撞击伤后，在CO2气腹状态下胃血流量的变化受失血量、气腹压力以及气腹持续时间3因素的影响较大。胃血流量减少均导致各组胃黏膜的病理学改变。
Objective To investigate the regional blood flow （ RBF） of the stomach within different intra - abdominal pressures during CO2 pneumoperitoneum （ PP） in a controlled hemorrhagic model with liver injuries. Methods Forty-five rabbits were divided into 6 groups（Ⅰ-Ⅵ ） according to the volume of blood lost and the intra - abdominal pressures （IAP）. Color-labeled microspheres were used to measure the RBF of stomach at the following moments such as pre-PP,30 minutes under PP,2 hours under PP and 30 minutes after deflation. Results When IAP was 5mmHg and 6ml/Kg blood lost,the RBF decreased remarkably after 2h under PP. When IAP was 5mmHg and 12ml/Kg blood lost,the RBF decreased remarkably after 30min under PP. The RBF decreased remarkably after 2h under PP, when IAP was lOmmHg and 6ml/Kg blood lost. When IAP was lOmmHg and 12ml/Kg blood lost,the IAP was 15mmHg, and the RBF decreased remarkably after 30min under PP. Conclusion The changes of the RBF of stomach is related with the volume of lost blood, the intra-abdominal pressures and the time under pneumoperitoneum after liver injuries. As the RBF decreases remarkably, the pathology changes include interstitial edema and inflammatory cell infiltration happen. And the gastric mucous membrane impaired. This may cause stress ulcer, transplant of microbial population, and systemic inflammatory response syndrome.
出处
《创伤外科杂志》
2007年第3期199-202,共4页
Journal of Traumatic Surgery
关键词
肝损伤
气腹
胃
血流量
腹腔镜
liver injury
pneumoperitoneum
stomach
regional blood flow
abdominoscope
