CO2气腹对兔失血性休克复苏后肾功能影响的研究

Effects of CO_2 pneumoperitoneum on renal function in rabbits after hemorrhagic shock and resuscitation

目的探讨CO2气腹对失血性休克复苏后兔肾功能的影响及其机制。方法制作失血性休克复苏兔模型,按中度休克(失血量12ml/kg)、重度休克(失血量25ml/kg)及CO2气腹压力(5、10、15mmHg)将实验动物随机分为6组(n=8)。检测气腹前、气腹30min、气腹2h以及撤去气腹后30min4个时相点的血肌酐(Cr)及尿素氮(BUN)水平,采用彩色微球法测量肾血流量(RBF)。结果中度休克时,5mmHg气腹压,气腹2h时Cr明显增高,RBF显著降低(P<0.05);10mmHgCO2气腹压,气腹30min时Cr即明显升高,2h时BUN显著上升、RBF明显下降(P<0.05);15mmHg气腹压,气腹30min时Cr和BUN均明显升高,而RBF显著降低(P<0.05)。重度休克时,CO2气腹后30min时各组试验兔Cr和BUN即显著升高,RBF则明显下降(P<0.05)。结论失血性休克复苏后建立CO2气腹,可导致肾功能障碍,其程度与CO2气腹压力、气腹时间及失血量导致的RBF下降密切相关。

Objective To investigate the effect of different intra-abdominal pressures as a result of CO2 inflation on renal function in rabbits after hemorrhagic shock and resuscitation and its mechanism Methods Rabbit model of hemorrhagic shock and resuscitation were established and randomly divided into 6 groups according to the volume of blood loss （12ml/kg and 25ml/kg, respectively, as intermediate and severe hemorrhagic shock rabbits） and the intra abdominal pressure （5, 10 and 15mmHg）. Venous blood samples were collected for the measurement of serum creatinine （C r） and blood urea nitrogen （BUN） before pneumoperitoneum, 30rain and 2h with , and 30min after deflation. The renal blood flow （RBF） was also evaluated with the color-labeled microspheres at the four time points as mentioned above Results In medium hemorrhagic shock rabbits, compared with that before ,Cr increased remarkably under the intra-abdominal pressure of 5mmHg for 2h and under the intra-abdominal pressure of 10mmHg for 30rain （P〈0. 05）. RBF decreased remarkably under the intra-abdominal pressure of 5mmHg and 10mmHg for 2h （P〈0. 05）. BUN increased remarkably under the intra-abdominal pressure of 10mmHg for 2h （P〈0. 05）. Levels of both Cr and BUN ascended remarkably at 30rain under 15mmHg pressure of pneumoperitoneum, while RBF reduced at the same time （P〈0. 05）. Cr and BUN increased and RBF decreased remarkably at 30rain in all groups of severe hemorrhagic shock rabbits （P〈 0. 05 ）. Conclusions To establish CO2 pneumoperitoneum after hemorrhagic shock and resuscitation may lead to the disturbance of renal function, which is related to the reduction of RBF as a result of increased intra abdominal pressure, pneumoperitoneum duration and volume of blood loss.