侧流暗场成像技术观察内毒素休克兔小肠绒毛与舌下微循环改变

发布时间：2018-06-16 09:00

本文选题：侧流暗场成像 + 微循环　；参考：《中国病理生理杂志》2017年04期

【摘要】：目的:利用侧流暗场(sidestream dark-field,SDF)成像技术观察比较内毒素休克兔经液体复苏至同一目标血压水平下小肠绒毛微循环及舌下微循环变化的异同。方法:新西兰大白兔60只,随机分为绒毛组及舌下组,每组30只。2组均行体外回肠造口术,用细菌脂多糖注射建立内毒素休克模型。建模成功后用乳酸林格氏液以复苏剂量30 mL·kg~(-1)·h~(-1)进行液体复苏使平均动脉压(MAP)达到80 mmHg为目标血压。若经单纯液体复苏,血压仍不能达标者,则予以去甲肾上腺素0.5~1μg·kg~(-1)·min~(-1)维持至目标血压。通过SDF成像技术持续观察2组动物休克前后以及液体复苏后的小肠绒毛及舌下微循环灌注指标:绒毛血管数量(vessels per villus,VV)、微血管血流指数(microvascular flow index,MFI)、灌注绒毛比例(proportion of perfused villi,PPVi)、绒毛边界量化评分、绒毛血管评分、总的血管密度(total vessel density,TVD)、灌注血管密度(perfused vessel density,PVD)、灌注血管比例(proportion of perfused vessels,PPVe)等的变化并比较两者灌注特点的异同。结果:休克后,小肠绒毛MFI、PPVi以及舌下微循环MFI、PPVe、TVD、PVD较休克前均显著下降(P0.01),其中小肠绒毛微循环MFI显著低于舌下微循环(P0.01);经液体复苏至MAP达到目标血压后,小肠绒毛MFI、PPVi以及舌下微循环MFI、PPVe、TVD、PVD较休克后均有明显上升(P0.05),但复苏后的小肠绒毛微循环MFI仍明显低于舌下微循环(P0.01)。结论:内毒素休克兔小肠绒毛与舌下微循环灌注变化有差异,休克后小肠绒毛微循环灌注下降程度较舌下微循环更显著,而液体复苏后小肠绒毛微循环灌注恢复程度亦低于舌下微循环。
[Abstract]:Aim: to observe and compare the changes of microcirculation in small intestine villi and sublingual microcirculation in endotoxic shock rabbits after fluid resuscitation to the same target blood pressure by using side stream dark-field SDF imaging technique. Methods: sixty New Zealand white rabbits were randomly divided into villus group and sublingual group. 30 rabbits in each group underwent ileostomy in vitro and endotoxic shock model was established by injection of bacterial lipopolysaccharide. After modeling successfully, Ringer's lactate solution was used to resuscitate the average arterial pressure (MAPP) of 80 mmHg with the resuscitation dose of 30 mL kg-1). If the blood pressure was still not up to the standard after pure fluid resuscitation, norepinephrine (0.5 渭 g 路kg ~ (-1) 路min ~ (-1) 路min ~ (-1) was administered to the target blood pressure. The indexes of microcirculation perfusion of small intestinal villi and sublingual villi before and after shock and fluid resuscitation in both groups were continuously observed by SDF-imaging technique: villous vessels per villus VVV, microvascular flow index MFI, and perfusion villi proportion of perfused. Villian PPVian, villi boundary quantitative score, The changes of chorionic villus score, total vessel density, perfusion vessel density and perfusion ratio of perfused vessels were compared and compared between the two groups. Results: after shock, the levels of PPVI in villi of small intestine and microcirculation in sublingual microcirculation in TVDV PVD decreased significantly compared with those before shock, and the MFI of microcirculation in villi of small intestine was significantly lower than that in sublingual microcirculation (P 0.01), and after fluid resuscitation, map reached the target blood pressure. Compared with those after shock, the MFI PPVI and the sublingual microcirculatory MFI TVDV PVD increased significantly (P 0.05), but the MFI of the resuscitation was still significantly lower than that of the sublingual microcirculation (P 0.01). Conclusion: the changes of microcirculation perfusion in small intestinal villi and sublingual villi in rabbits with endotoxic shock are different, and the degree of microcirculation perfusion in villi of small intestine after shock is more significant than that in sublingual microcirculation. After fluid resuscitation, the recovery degree of microcirculation in villi was also lower than that in sublingual microcirculation.
【作者单位】：遵义医学院附属医院重症医学科;
【基金】：国家自然科学基金资助项目(No.81560308) 贵州省科学技术基金资助项目(黔科合J字[2010]2180号)
【分类号】：R459.7

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