胆道加压对重症急性胆管炎家兔血液动力学的影响

Influence of biliary hypertension on hemodynamics in rabbits With ACST

本文采用１２只日本长耳家兔复制重症急性胆管炎（ＡＣＳＴ）模型，并利用自制“盲囊”加压装置形成胆道高压，观察其血液动力学指标的变化，旨在探讨胆道高压和感染因素在ＡＣＳＴ发病机理中的作用及关系。结果发现：在２０ｋＰａ（１５０ｍｍＨｇ）持续胆道加压１２０分钟内，血内毒素水平无明显增加（Ｐ＞０．０５），而平均动脉压（ＭＡＰ）的下降幅度超过４ｋＰａ（３０ｍｍＨｇ）、心输出量也明显降低（Ｐ＜０．０５），当胆道减压后，ＭＡＰ和心输出量逐渐恢复，其中３例的血压降至０后未能恢复，最终死亡。同时右内脏大神经放电频率增加（Ｐ＜０．０５），且减压后又下降。由此可见，急剧的胆道压力升高是导致ＡＣＳＴ血压下降的重要因素，甚至可以造成不可逆性休克，此种影响与内脏神经活动有关。

An experimental model of acute cholangitis in severe type (ACST)was re-produced in 12 Japanese big ear white rabbits, in which a catheter with an inflatablerubber bag(self-made) fixed to its anterior end was inserted into the extrahepatic biliarytract via the duodenum, and biliary high pressure of 20 kPa(150mmH) was created andmaintained for 2hr by inflating the bag with water. Hemodynamics changes were investi-gated to explore the effect of biliary high pressure and infection in ACST. Although theresults of quantitation of venous blood endotoxin before and after hypertension showed nosignificant decline(P>0.05),the decrease of mean atery pressure (MAP) surpassed 4 kPa(30mmHg),and cardiac output showed significant decline(P<0. 05).Biliary decompressiongradually reversed the above abnormalities. Of 3 cases whose blood pressure rapidly fell to0 kPa were died in shock within 2 hr.On the other hand, a rise of impulse frequency ofthe right major splanchnic nerve was recorded after biliary compression(P<0.05).Theauthors believed that sharp increase of biliary pressure was important factor resulting inblood pressure drop or unrecovery shock, the effects were related to the act ivity of Splan-chnic nerves.