动态观察兔缺血肠管微循环判断其肠活力

Prediction of Intestinal Viability by Dynamic Observing Microcirculation of Ischemic Intestine in Rabbit

用３２只白兔做成６４段缺血肠袢模型，肠袢缺血时间分别为９０、１５０、２１０、２７０ｍｉｎ。去阻断后１５ｍｉｎ先由有经验的外科医生根据临床标准判断肠管是否失活，再用显微镜（放大５００倍）沿实验肠管肠系膜对缘肠壁分１０点观察。２４ｈ后再次开腹探查，根据临床标准判断肠管活力。结果发现当１０个视野中有８个以上视野有血流即可判断该肠管有活力。这一方法明显优于标准临床判断法（Ｐ＜０．００１）与２４ｈ２次手术探查法相比，无显著性差异（Ｐ＞０．０５）。肠壁缺血时微循环的上要病理改变是：红细胞聚集、白细胞贴壁翻滚、微血管渗出及漏出性出血。

Microcirculation microscope was used to determine the viability of ischemic small intestine by dynamic observing microcirculation of ischemic intestine.Sixty-four ischemic segments of small intestine were produced in thirty-two rabbits by clamping vascular supply. The clamping time of ischemic intestine was 90,150, 210,270min respectively.Fifteen minutes after restoration of the circulation,the intestine was assessed for viability using standard clinical criteria by an experienced surgeon and then the microcirculation microscope was passed along the antimesenteric surface of the ischemic intestine in ten points.After twenty-four hours,second-look laparotomy was done to determine the viability of ischemic intestine depend upon standard clinical criteria.Laboratory studies show that 8/10 is a reliable criteria for determing the viability of experimental created ischemic intestine.It demonstrated that microscope observation was a more reliable intraoperative predictor of viability of ischemic intestine than clinical assessment,and there was no statistically significant than the second-look laparotomy.The major pathological changes of microcirculation of the ischemic intestine were aggregation of erythrocytes,leukocyte rolling,edema,hemorrhage and blood stagnation.