肝脏撞击伤致心脏间接损伤后左心室功能变化的实验研究

Experimental study on changes of left ventricular function after liver impact injury in pigs

目的探讨肝脏撞击伤对猪左心室功能的影响。方法14只健康家猪随机分为撞击组(10只)和对照组(4只)。采用自制小型撞击器撞击组猪肝区,建立急性肝撞击伤动物模型。撞击前、撞击后即刻采用超声心动图评估左心室功能。剖杀实验动物,观察心脏大体损伤情况,取样浸泡,进行光镜和电镜检查。结果撞击后即刻,8例左心室整体舒张和收缩功能较撞击前下降。对照组左心室功能无明显变化。大体标本显示撞击组8例发生不同程度的左心室心内膜下呈片状、点状出血,2例未见明显损伤。光镜下和电镜下可见心肌细胞发生不同程度的损伤。对照组未见明显异常改变。结论肝脏撞击伤后导致心脏发生间接损伤,左心室收缩和舒张功能均下降,超声心动图检查能快速、准确评估心功能的变化,为临床救治提供有价值的信息。

Objective To explore the effects of impact injury of liver on left ventricular function in pigs. Methods Fourteen pigs were randomly divided into the impact group（ n = 10） and the control group（ n = 4）. Selfmade impactor was used to impact the pigs to make animal models with acute blunt hepatic trauma. Traditional echocardiography was performed to evaluate the changes of the left ventricular function before liver injury and instantly after the impact. Gross pathologic, microscopic and electron microscopic examination were performed to detect the changes of the injured hearts. Results In the impact group,left ventricular diastole function decreased in eight cases and left ventricular systolic function had no great change in all cases instantly after the impact. Lamellar and punctate hemorrhages under the left ventricle endocardium were found in all cases except two by gross pathologic examinations. Myocardial cell injuries were detected by the light microscope and electron microscope. There was no obvious change on left ventricular function and pathology in the control group. Conclusion The impact injury to liver often leads to the indirect injury of heart,which results in the injury of left ventricular function in pigs. Echocardiography can quickly and accurately detect the changes of left ventricular function, which can provide useful information for clinical remedy.