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目的探讨失血性休克复苏后CO2气腹状态下兔肝功能(hepatic function,HF)及肝血流量(hepatic bloodflow,HBF)的变化。方法制作中度(失血量12 ml/kg)及重度(失血量25 ml/kg)失血性休克复苏兔模型,复苏后建立CO2气腹,将50只新西兰白兔按失血量及CO2气腹压(5、10、15 mmHg)用随机数字表法分为6组。观察气腹前、气腹30 min、气腹2 h以及撤去气腹后30 min 4个时相点谷草转氨酶(aspartate aminotransferase,AST)和谷丙转氨酶(alanineaminotransferase,ALT)的变化,并应用彩色微球法检测HBF的变化。结果气腹前重度休克组的AST和ALT较中度休克组显著增高(P<0.05),HBF则呈降低趋势。中度休克组5 mmHg CO2气腹后30 min时AST、气腹2 h时ALT显著升高,而10 mmHg和15 mmHg气腹压30 min时AST和ALT明显增高(P<0.05);重度休克组气腹后30 min时AST和ALT明显上升(P<0.05)。中度休克组5 mmHg和10 mmHg CO2气腹压2 h时HBF明显减少(P<0.05),而15 mmHg气腹压30 min时HBF显著下降(P<0.05);重度休克组气腹后30 min时HBF明显降低(P<0.05)。结论中度及重度失血性休克复苏后,CO气腹对肝功能的影响与失血量、气腹压力和气腹时间关系密切。
Objective To investigate the changes of hepatic function (HF) and hepatic blood flow (HBF) in CO2 pneumoperitoneum after hemorrhagic shock resuscitation. Methods Rabbit models of hemorrhagic shock with moderate (blood loss of 12 ml / kg) and severe (blood loss of 25 ml / kg) were made. CO2 pneumoperitoneum was established after resuscitation. Fifty New Zealand white rabbits were sacrificed by blood loss and CO2 pneumoperitoneum (5,10,15 mmHg) were divided into 6 groups by random number table. The changes of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were observed before and after pneumoperitoneum for 30 min, pneumoperitoneum 2 h, and pneumoperitoneum 30 min after removal of pneumoperitoneum. Ball method to detect changes in HBF. Results Severe pneumoperitoneum before shock group AST and ALT were significantly higher than those in moderate shock group (P <0.05), HBF showed a downward trend. In moderate shock group, AST and ALT increased significantly at 2 h after pneumoperitoneum at 5 mmHg CO2 and 30 min after pneumoperitoneum, while AST and ALT at 10 mmHg and 15 mmHg pneumoperitoneum were significantly increased at 30 min (P <0.05) AST and ALT were significantly increased at 30 min after pneumoperitoneum (P <0.05). HBF was significantly decreased at 5 mmHg and 10 mmHg CO2 pneumoperitoneum in moderate shock group at 2 h (P <0.05), while HBF decreased significantly at 15 mmHg pneumoperitoneum pressure at 30 min (P <0.05) HBF was significantly lower (P <0.05). Conclusion The effect of CO pneumoperitoneum on liver function after moderate and severe hemorrhagic shock resuscitation is closely related to blood loss, pneumoperitoneum pressure and pneumoperitoneum time.