重症急性胰腺炎合并腹腔间隔室综合征减压时机的选择

Optimal time of decompression for acute pancreatitis combined with abdominal compartment syndrome

目的评价选择不同时间点开腹对模型猪重症急性胰腺炎（SAP）合并腹腔间隔室综合征（ACS）的减压效果。方法测量基线实验数值后，24头猪随机（随机数字法）均分为3组：SAP组、SAP＋ACS组（6 h后开腹减压）、AP＋ACS组（12 h后开腹减压）。采用胰胆管逆行注入牛黄胆酸钠建立SAP模型，氮气气腹法建立气腹模型并将腹内压升高至25 mmHg（1 mmHg=0.133 kPa）。持续观察24 h，记录实验动物血流动力学、尿量、氧合、血生化指标。结果ACS模型建立后，动物的血流动力学和氧合迅速恶化，12 h开腹减压组的生存时间较6 h组显著缩短（P=0.008）。6 h开腹减压组的模型猪血流动力学、全身氧合、器官功能、炎性反应指标在减压后与SAP对照组类似，而12 h开腹减压组的模型猪血流动力学，氧合及器官功能则显著差于其余两组，如心排出量水平三组在实验终点分别为：SAP组（2.70±0.50）L/min，6h组（2.75±0.48）L/min，12 h开腹组（2.19±0.43）L/min。结论早期开腹减压可以明显降低重症急性胰腺炎合并腹腔间隔室综合征的猪模型的病死率，改善血流动力学、器官功能及炎性反应程度。

Objective The aim of this study was to evaluate the optimal time for decompression in a 24-hour lasting porcine model. Methods After baseline data were recorded, 24 pigs were randomly allocated into three groups as follows ： one SAP-alone group, and two SAP ± ACS groups （ decompression at 6 and 12 hours, respectively）. We used a N2 pneumoperitoneum to increase the intra-abdominal pressure to 25 mmHg and retrograde intra-ductal infusion of sodium tauroeholate to induce severe acute pancreatitis （SAP）. Systemic hemodynamic profiles, urine output, systemic oxygenation, and serum biochemical parameters of the animals were obtained. Results After induction of ACS, the hemodynamies and oxygenation of the study animals deteriorated significantly. The survival time of the 12-hour group was significantly shortened （ P = 0. 008 vs. 6 hours ）. Early decompression （ 6 h ） restored systemic hemodynamies, oxygenation, organ function, and inflammatory intensity to a level comparable to that of the SAP-alone group. In contrast, animals in 12-hour group developed more severe hemodynamic suppression, oxygenation and organ dysfunction and inflammatory process. For instance, the cardiac output levels in the three groups were 2. 70 ±0. 50 for the SAP group, 2. 75 ±0. 48 for the 6 hour-group and 2. 19 ±0. 43 for the 12 hour-group. Conclusion Early decompression could significantly reduce the mortality in a porcine model of SAP incorporating ACS, and also improve systemic hemedynamics, organ function and inflammatory intensity.