猪急性肾衰竭并多器官功能障碍模型建立及病理观察

Establishment and Pathological Observation of A Pig Model with Acute Renal Failure and Multiple Organ Dysfunction Syndromes

目的:建立一个重症感染后多器官功能障碍综合征(MODS)并急性肾衰竭(ARF)复合的猪模型。方法:16只健康杂交家猪随机分成模型组和假手术对照组。模型组行盲肠结扎和穿孔(CLP),加作肾动脉夹闭(CRA)制作腹腔感染致MODS并ARF模型,对照组行盲肠和双肾探查术。观察生命体征及主要器官功能(MODS相关指标)变化。结果:模型组术后24～72h出现器官功能障碍:(1)ARF:血清肌酐(Scr)、尿素氮(BUN)分别从(92.70±11.05)μmol/L、(4.16±1.02)mmol/L升至(986.37±132.61)μmol/L、(48.13±2.68)mmol/L。(2)肝功能:血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)均超过对照值的2倍;(3)凝血功能:血小板数<80%对照值,且皮肤可见弥漫或散在的出血点;(4)心功能:平均动脉压(MAP)持续≤70%对照值,且呈进行性下降;心率≥130次/min;(5)肺功能:动脉血二氧化碳分压(PaO2)下降,低于69.75mmHg;呼吸频率增快,均值超过照值的2倍;(6)胃肠功能障碍;(7)肾、肝、脾、肺及小肠等器官组织病理上均有不同程度的实质性改变。模型组动物6d内全部死亡,平均存活时间(69.81±22.59)h;对照组全部存活,且器官功能无明显变化。结论:采用CLP+CRA方法,可以成功地复制出MODS并ARF复合模型,并可见最终均发展为多器官衰竭。

Objective：To establish a composite pig model with multiple organ dysfunction syndrome（MODS） and acute renal failure（ARF）.Methods：Sixteen pigs were randomly divided into two groups：group E received cecal ligation and puncture（CLP） plus clamping of the renal artery（CRA） and group C received sham operation.Vital signs and the functions of the main organs were observed.Results：Seventy-two hours after operation,animals in the model group showed ARF and MODS-like changes：（1）Gastrointestinal dysfunction;（2）The enhanced indexes of renal and liver function,including serum Cr,BUN,ALT and AST;（3）Pulmonary dysfunction,such as PaCO2 from（38.04±2.98）mmHg to（52.14±4.62）mmHg（P〈0.01）;（4）Cardiac dysfunction,such as the reduction of MAP and the increase of heart rate;（5）Dysfunction of blood coagulation,such as the decrease of blood platelet;（6）The survival time in group E was（69.81±22.59） hours.（7）Severe pathological lesions were observed in the lung,liver,heart,kidney and gut,etc.Conclusion：In the course of MODS and ARF caused by intra-abdominal infection and clamping of the renal artery,the main organs deteriorated progressively and it finally became multiple organ failure.