不同腹腔减压方式对腹腔间室综合征大鼠肠道功能的影响

The effects of different decompression methods on intestinal and other organs function

目的:观察腹腔开放减压和腹腔梯度减压两种方式对腹腔间室综合征(ACS)大鼠肠黏膜屏障的影响。方法:将18只大鼠模型随机分为对照组、开放减压组和梯度减压组。其中开放减压组大鼠ACS持续4 h后,经腹正中切口迅速使腹腔压力(IAP)降至0 mm Hg;梯度减压组大鼠ACS持续4 h后,通过减慢气腹充气速度,以ΔIAP=-0.5 mm Hg/min的速度减压,直至IAP恢复至0 mm Hg(减压时间为50 min)。在IAP降至0 mm Hg后4h处死动物,取末端回肠行组织病理学检查、肠系膜淋巴结细菌易位测定、肠黏膜组织肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)和肠型脂肪酸结合蛋白(i-FABP)测定。结果:梯度减压组与开放减压组比较,肠道病理损伤更小,细菌易位率更低,炎性因子水平更低。其中肠道通透性、细菌易位菌落数、IL-6水平在不同减压方式组之间差异有统计学意义(P<0.05)。结论:不同的腹腔减压方式对ACS大鼠的肠道功能影响不同。梯度腹腔减压比开放减压对ACS大鼠肠道功能的损伤更小。

Objective： To observe the effects of open abdominal decompression and gradient decompression on intestinal mucosal barrier and organ functions. Methods： 18 male SD rats（ body weight 250 ~ 300 g） were randomly divided into control group,open decompression group and gradient decompression group. In the open decompression group,IAP immediately fell to 0 mm Hg through abdominal central incision. In the gradient decompression group,IAP was reduced by 0. 5 mm Hg / min until it returned to 0 mm Hg（ reduced time 50 min）. At 4hours after IAP = 0 mm Hg,distal ileum was collected for mucosal barrier damage assessment,including histopathology,detection of in vitro intestinal permeability,bacterial translocation in mesenteric lymph nodes（ MLN）,intestinal inflammation（ TNF-α,IL-6） and ischemia-reperfusion injury（ i-FABP） assessment. Results： Compared with the open decompression group,intestinal structure and function were more intact in the gradient decompression group. The differences in bacterial translocation and IL-6 were significant（ P〈0. 05）. Conclusion： Gradient abdominal decompression causes less intestinal damage in ACS rats than traditional abdominal decompression.