CO_2气腹对肝硬化兔肝脏血流的影响

Influence of carbon dioxide pneumoperitoneum on the liver circulation in cirrhotic rabbits

目的:探讨CO2 气腹对肝硬化兔肝脏血流循环及肝功能的影响。方法:制备肝硬化兔模型,于不同的CO2 气腹,用彩色多普勒超声腹腔内检测门静脉、肝动脉和背主动脉的血流速度、管内径和肝动脉阻力指数,监测心率,计算血流量、门静脉淤血指数。检测气腹前后兔肝功能。结果:腹内压升高,肝硬化组和对照组兔背主动脉血流、心率改变差异无显著性;门静脉血流降低,肝硬化组于10mmHg气腹压下减少45. 5% (P<0. 05),同时肝动脉血流增加,肝脏总体循环血流减少,肝功能受损,肝硬化兔改变稍明显,但两组差异无显著性。系统血供(背主动脉血流)与肝脏血流无关联(P>0. 05),门静脉血流与腹内压有相关性(P<0. 05),肝动脉血流与动脉阻力指数呈负相关(P<0. 05)。结论:CO2 气腹对肝硬化兔肝脏血流影响较大,门静脉血流显著降低且肝动脉缓冲效应减弱;肝硬化兔肝功能更易受损。尽管实验中低于10mmHgCO2 气腹对肝硬化兔肝脏血流影响较轻,但肝硬化患者行腹腔镜手术时仍需注意腹内压力和气腹持续时间。

Objective:To investigate the influence of carbon dioxide pneumoperitoneum on liver circulation and liver function in cirrhotic rabbits Methods:Cirrhotic rabbit model was replicated and performed intraperitoneal color doppler ultrasonography on the measurement of blood stream velocities and innerdiameters of portal vein, hepatic artery and dorsal aorta with different intraabdominal pressure (IAP) during carbon dioxide insufflation At the same time, hepatic arterial resistance index (RI) was measured Heart rate (HR) was monitored in parallel with the increase of IAP Volumes of blood flow and congestive index (CI) of portal vein were calculated as well The blood samples were taken to analyze liver function before insufflation and after desufflation Results:No significant differences were observed in changes of dorsal aorta blood flow (DABF) and HR between two groups In both groups, portal venous blood flow (PVBF) decreased, hepatic arterial blood flow (HABF) increased, total hepatic blood flow (THBF) diminished, and liver function impaired with elevated IAP. And changes of rabbits with cirrhosis in early stage were slightly greater than those of the control group, although no marked differences were observed in these parameters between cirrhotic and control groups with IAP no more than 10mm Hg. But PVBF reduced by 45 5% at 10mm Hg IAP (P<0.05) in cirrhotic group. In addition, PVBF was reduced in relation to IAP (P<0 05), while HABF was raised by the reduction in arterial RI (P<0 05) There was no correlation (P>0 05) between systemic supply (DABF) and liver blood flow Conclusions:Carbon dioxide pneumoperitoneum has great influence on liver circulation in cirrhotic rabbits due to the markedly decreased portal venous inflow and impaired hepatic arterial buffer response The liver function is more susceptible to be damaged in cirrhotic rabbits The findings of this study suggest that carbon dioxide pneumoperitoneum at less than 10mm Hg presents slight influence on liver blood flow in cirrhotic rabbits; however, more attention should be paid to the IAP and duration of carbon dioxide pneumoperitoneum in patients with cirrhosis undergoing laparoscopic surgery