失血性休克复苏后CO2气腹对兔肝功能及肝血流量的影响.docVIP

失血性休克复苏后CO2气腹对兔肝功能及肝血流量的影响 贾立峰，张连阳，李勇( (第三军医大学大坪医院野战外科研究所全军战创伤中心，重庆 400042) 摘　要：目的 探讨失血性休克复苏后CO2气腹状态下兔肝功能(hepatic function,HF)及肝血流量（hepatic blood flow,HBF）的变化。方法 制作中度（失血量12ml/kg）及重度（失血量25ml/kg）失血性休克复苏兔模型，复苏后建立CO2气腹，50只新西兰白兔按失血量及CO2气腹压（5、10、15mmHg）用随机数字表分为6组。观察气腹前、气腹30min、气腹2h以及撤去气腹后30min 4个时相点谷草转氨酶（aspartate aminotransferase,AST）和谷丙转氨酶（alanine aminotransferase,ALT）的变化，并应用彩色微球法检测HBF的变化。结果 气腹前重度休克组的AST和ALT较中度休克组显著增高（P0.05），HBF则呈降低趋势。中度休克组5mmHg CO2气腹后30min时AST、2h时ALT显著升高，而10mmHg和15mmHg气腹压30min时AST和ALT即明显增高（P0.05）；重度休克组气腹后30min时AST和ALT即明显上升（P0.05）。中度休克组5mmHg和10mmHg CO2气腹压2h时HBF明显减少（P0.05），而15mmHg气腹压30min时HBF即显著下降（P0.05）；重度休克组气腹后30min时HBF即明显降低（P0.05）。结论 中度及重度失血性休克复苏后，CO2气腹对肝功能的影响与失血量、气腹压力和气腹时间关系密切。 关键词：失血性休克；CO2气腹；肝功能；兔 Eeffects of CO2 pneumoperitoneum on hepatic function and hepatic blood flow to hemorrhagic shock resuscitation in rabbits JIA Li-Feng,ZHANG Lian-yang,LI Yong.(Department of Trauma and Injuries, Institute of Surgical Research, Daping Hospital, Third Medical Military University, Chongqing 400042, China) Abstract: Object To investigate the change of hepatic function(HF) and hepatic blood flow(HBF)under different intra-abdominal pressures(IAP) during CO2 pneumoperitoneum(PP)to hemorrhagic shock resuscitation in rabbits．Methods Fifty New Zealand rabbits were randomized into 6 groups according to the volume of blood loss(12ml/kg,25ml/kg) and IAP (5mmHg, 10mmHg, 15mmHg)．After of model, aspartate aminotransferase (AST) ,alanine aminotransferase (ALT), HBF were observed at time of pre-insufflation of CO2，under PP，2h under and 0.5h after desufflation．Results Compare with pre-insuffflation, AST of the group of intermediate hemorrhagic shock statistically increased even at 0.5h under CO2 PP of 5mmHg, and the ALT significantly elevated at 2h(P 0.05).Significant increase in AST and ALT of the group of intermediate hemorrhagic shock were seen even at 0.5h under IAP of 10mmHg and 15mmHg(P 0.05). AST and ALT of the group of severe hemorrhagic shock significantly incr