不同体位气腹对家兔颅内压及脑水肿的影响

Influence of different positions of pneumoperitoneum on intracranial pressure and incidence of cerebral edema of rabbits

目的观察气腹条件下不同特伦伯格体位家兔颅内压力的变化及脑水肿情况。方法36只普通级雌性新西兰兔均分为A、B、C组(A组平卧位、B组头低位20°、C组头低位30°),建立家兔CO_(2)气腹模型,在气腹后2、3及4 h测量家兔颅内压力,处死家兔后测量脑组织含水量,苏木素伊红(HE)染色观察脑组织学变化。结果3组家兔的颅内压力、脑组织含水量随人工气腹后时间延长(2、3、4 h)呈上升趋势,A组<B组<C组(P<0.05);3个时点3组家兔脑组织干重、湿重比较,差异无统计学意义(P>0.05);随头低位角度增加,家兔颅内压力和脑组织含水量呈上升趋势,A组<B组<C组(P<0.05);HE染色发现3组家兔的脑水肿的病理改变3 h开始出现、4 h水肿较明显,但同时点3组比较差异无统计学意义(P>0.05)。结论气腹时间及T位的倾斜角度会影响家兔颅内压和脑水肿,但脑水肿的病理改变可能与气腹时间有关而与体位无关。

Objective To observe the changes of intracranial pressure and cerebral edema of rabbits in different Trendelenburg position(T position)under pneumoperitoneum.Methods Thirty-six female New Zealand rabbits of common grade were randomly divided into Group A,B,and C(Group A was supine,Group B had A low head position of 20°,and Group C had A low head position of 30°).The CO_(2) pneumoperitoneum model of rabbits was established.Intracranial pressure was measured for 2 h,3 h and 4 h after pneumoperitoneum.The pathological changes of brain tissues were observed by hematoxylin eosin(HE)staining.After data collection and processing,SPSS was used for statistical analysis of the data,while repeated measurement analysis of variance was used for statistical analysis of quantitative data of different groups at different time points,and LSD test was used for pair comparison of different groups.Results The intracranial pressure,dry weight,wet weight and water content of brain tissues in Group A,B and C were compared.(P<0.05),the dry weight and wet weight of experimental rabbits in the three groups showed no change trend with the passage at the 3 time points(P>0.05),inter-group comparison:the intracranial pressure and brain tissue water content increased with the increase of low head angle(P<0.05).HE staining showed that there was a certain correlation between the pathological changes of cerebral edema and the time of pneumoperitoneum.The cerebral edema appeared in 3 h and was more obvious in 4 h,but it had no obvious correlation with the group.Conclusion Pneumoperitoneum time and T position are the independent factors affecting the intracranial pressure and cerebral edema of the rabbits,T a change along with the extension of time,the rabbit brain tissues of intracranial pressure and brain tissue water content is on the rise,the pathological results showed pathological changes of brain edema may be related to the length of time of pneumoperitoneum,and no obvious correlation with the position.