对绞窄性肠梗阻早期实验室诊断的进一步探讨

FUTHER STUDY ON EARLY DIAGNOSIS OF EXPERIMENTAL ACUTE INTESTIANAL ISCHEMIA (ABSTRACT)

采用Encoer Ⅱ型全自动生化分析仪和乙酸纤维膜电泳法对不同肠绞窄程度的犬血清和腹液进行连续检测,观察肌酸激酶及其同功酶和磷的改变。实验发现,对绞窄性肠梗阻的早期诊断不应晚于肠缺血后4小时。当肠壁血运障碍时,CK及磷可被大量释放入血引起升高。CK-BB型同功酶在肠绞窄2小时时己有显著性升高(P<0.01),由于其主要存在于胃肠道,无疑对肠绞窄的早期诊断有一定特异性。而CK,CK-MM,CK-MB和磷由于出现显著性升高较晚,早期诊断意义不大。同时实验还发现,各组动物在解除肠绞窄恢复其血运后,可突然出现CK及其同功酶活性和磷水平的升高。我们认为这是一种与缺血再灌注加重损伤有关的反应,提示我们在手术治疗中应注意到可能发生的迟发性肠组织损伤。

Total CK, CK-isoenzyme and phosphate levels were determined dyautomated spectrophotometric analysis using a Encoer 11 autoanalyzerand cellulose acetate electrophoresis. Serum and ascites samples obta-ined from dogs who were selected to have the intestinal infarction with four different degree. Based upon the data, we recongnize thatthe early diagnosis must be established befor four hours of ischemia.Ischemia injure to the intestinal tissue causes a release of intracellularCK, CK-isoenzyme and phosphate into the circulation. The significantelevation of CK-BB in serum and ascites occurred before two hours ofischemia (P<0.01), the significant elevation of CK, CK-MM, CK-MBand phosphat levels occourred after four hours of ischemia. Thesefoudings suggest that CK-BB is a sensitive indicator of intestinalischemia and others have no early diagnosis value. In this study thelevels of CK, phosphate and CK-isoenzyme rose suddenly after remov-ing ischemia, it related to the fact that the development of damage insmall intestinal ischemia started not only during the hypotensive periodbut that significant damage also in the immediate post-hypotensiveperiod, we must pay more attention to this.