创伤失血性休克后腹腔压力升高对机体脏器功能影响的实验研究

Influence of increased intra-abdminal pressure on organ function after traumatic hemorrhagic shock

目的探讨创伤失血性休克后大量液体复苏引起腹腔压力升高对机体脏器功能的影响。方法W istar大鼠32只随机分为腹压0、7、15、20mmHg组共4组;每组分别测动脉压、尿量、肝肾功能、血气分析、小肠、肠系膜组织血管渗透性。结果当腹腔压力为20mmHg时,动脉压开始显著上升,1小时后下降(P<0.01);尿量减少(P<0.01);血pH值进一步下降(P<0.05);血清ALT、AST和BUN无显著差异;肠系膜渗漏在0mmHg和20mmHg较7mmHg和15mmHg显著增加(P<0.05),而小肠渗漏在15mmHg时即开始升高。结论创伤失血性休克2小时后经大量液体复苏,腹腔压力与小肠及肠系膜血管渗漏密切有关;当腹腔压达20mmHg时血流动力学、尿量和血pH值出现显著变化。

Objective To investigate the effect of increased intra-abdominal pressure on organs after traumatic hemorrhagic shock in rats. Methods Thirty-two Wistar rats were randomly divided into 4 groups according to the level of intra-abdominal pressure： 0 mmHg group,TmmHg group, 15mmHg group and 20mmHg group. Hepatic and renal functions were detected by automatic biochemistry analyzer, and arterial blood pressure, urine output blood,pH and changes of microvascular permeability of small intestine and mesentery were determined by Evens Blue method. Results When intra-abdominal pressure （IAP） was maintained at 20 mmHg for 1 hour, urine volume obviously decreased ,and blood pH decreased at 15mmHg of IAP. Arterial blood pressure increased at first then declined markedly after 1 hour,but serum ALT,AST and BUN. Cr did not change obviously. Microvascular permeability of mesentery increased obviously （ P 〈 0.05） in 0mmHg and 20mmHg groups as compared to 7mmHg and 15mmHg groups. But microvascular permeability of small intestine began to rise at 15mmHg of IAP. Conclusion Microvascular leakage of small intestine and mesentery are related to IAP in rat of under strenuous fluid resuscitation after traumatic hemorrhagic shock for 2 hours ; When IAP was 20mmHg, haemodynamics, urine output and blood pH are significantly aggravated.