胆道灌注4℃低温液体对于创伤肝脏的保护作用

发布时间：2018-06-10 18:59

本文选题：胆道灌注 + 低温治疗　；参考：《第二军医大学》2014年硕士论文

【摘要】：研究背景和目的：尽管肝脏位于肋骨弓下这个相对于受保护的位置，但它却是腹部损伤中较为常见的器官，仅次于脾和小肠。对于右腹部外伤来说，肝大多会受累。而当今交通事故的屡见不鲜以及各种反社会、反人类的暴力行为的频频发生，成为肝脏损伤的主要原因。肝脏损伤会造成大量的失血以及炎症因子的大量释放，使得机体产生严重的低血压性休克和炎症反应。因此，当肝脏损伤发生时，迅速的转运以及争分夺秒的抢救措施就成为了关系到伤员生死的决定性因素。低温治疗作为一种新型的治疗方法，在近年来由于其被广泛应用于临床而持续受到关注，在心脏骤停、神经损伤以及新生儿缺血缺氧性脑病等领域，该方法已经取得了公认的效果。在临床前期试验中的数据和结果显示，低温具有降低细胞代谢，抑制细胞凋亡等作用，使得一些专家提出低温治疗可以在创伤领域得到应用，但低温治疗在腹部创伤尤其是肝胆外科的应用还鲜有报道，就像对心脏、神经等创伤的保护作用一样，，我们考虑低温对于机体的保护作用一定也适用于肝脏。我们进行这项研究，通过做一个前瞻性、随机对照的动物肝损伤失血性休克的模型，观察创伤后的生理反应及其各项检测指标，来探索胆道灌注4°C低温液体对于创伤肝脏的实际降温效果及其保护作用。研究方法：实验方案设计是用来模拟实际肝创伤失血性休克紧急救治的，为了实验的统一性与可靠性，我们用两片手术刀片尾端重合来对13头麻醉后的年龄体重相仿的雄性巴马小型猪进行一个标准的肝损伤的处理。在15分钟的非控制性出血后进行像纱布按压及补液等简单的临时救治，1小时后，13只动物按照先前用随机数表所分好的那样随机入组。对照（Control）组7头，进行标准的外科肝伤救治方法；低温(Hypothermia)组6只，同样进行标准的肝伤救治方法，但额外进行4°C乳酸钠林格注射液的胆道灌注。每头动物都在同样的环境下饲养7天来对胆道灌注低温液体诱导低温治疗的效果进行一个评估。手术期间，所有的血压、心率、肝温、体温都全程记录，手术中4次由猪前腔静脉采血，术后1、3、5、7天同样各一次采血，来检测血常规及肝肾功能。实验结束时将动物处死，取右前叶肝组织做病理切片，H-E染色，观察炎性细胞侵润情况。研究结果：对照组和低温组各有一头猪由于伤势过重，失血过多，于术后第二天死亡，排除这两头猪，其余所有动物均生存到了术后第7天。实验过程中，对照组和低温组初期失血量、各检测时间点心率和平均动脉压均无明显差异，经不同干预方法2h后，C组和H组肝温分别下降1.17±0.68℃和2.08±0.21℃，两组间差异有统计学意义（P=0.020）；同一时段两组体温分别下降0.93±0.83℃和0.48±0.75℃，差异无统计学意义（P=0.40）。由于转氨酶指标是呈偏态分布的，所以要取相应的对数值来对其进行描述，log(AST)在第5天时，P=0.016，差异有显著性；log（AST）在术后灌注2小时后，P=0.026，差异有显著性。病理切片示低温组肝脏炎性细胞侵润程度明显轻于对照组。研究结论：胆道灌注4°C低温液体，能够减少创伤肝脏的炎症反应，有利于肝功能的恢复，从而对肝脏具有保护作用。
[Abstract]:Research background and purpose:
Although the liver is located under the protected position of the rib arch, it is the most common organ in the abdominal injury, second only to the spleen and the small intestine. For the right abdominal trauma, most of the liver is involved. The frequent occurrence of traffic accidents and the frequent occurrence of anti human violence and the liver injury are common in today's traffic accidents. The main reason is that liver damage can cause a large amount of blood loss and the release of inflammatory factors, causing the body to produce severe hypotensive shock and inflammation. Therefore, when the liver injury occurs, rapid transit and second rescue measures have become a decisive factor in the life and death of the wounded.
As a new method of treatment, cryogenic therapy has been paid more and more attention in recent years because of its widespread application in clinical practice. This method has been recognized in the fields of cardiac arrest, nerve injury and neonatal ischemic hypoxic encephalopathy. Some experts suggest that cryogenic treatment can be used in the field of trauma, but the application of cryogenic treatment in abdominal trauma, especially in the Department of hepatobiliary surgery, is rarely reported, like the protection of heart and nerve injuries. We consider that the protective effect of low temperature on the body must also be applied. In the liver.
We conducted a study of a prospective, randomized, controlled, randomized, controlled model of hemorrhagic shock in animal liver injury, and to observe the physiological responses and detection indexes after trauma to explore the actual cooling effect and protection of the 4 degree C cryogenic liquid for the bile duct perfusion for the traumatic liver.
Research methods:
The experimental scheme was designed to simulate the emergency treatment of hemorrhagic shock in the liver. For the purpose of testing the unity and reliability of the experiment, we used the tail end of two surgical blades to deal with a standard liver injury in male Bama miniature pigs of the same age after 13 anaesthesia. After 15 minutes of uncontrolled bleeding, we followed. 1 hours after 1 hours, 13 animals were randomly assigned to the group as well as a random number table. A standard surgical treatment of liver injury was performed in a control group (Control), and 6 in the group of low temperature (Hypothermia) were treated with the same standard for the treatment of liver injury, but an additional 4 degree C lactate ringer was carried out. In the same environment, each animal was kept in the same environment for 7 days to assess the effect of hypothermia therapy on biliary tract perfusion. During the operation, all the blood pressure, heart rate, liver temperature and body temperature were recorded, and the blood was collected from the anterior vena cava in the operation 4 times during the operation, and the same blood was collected on 1,3,5,7 days after the operation. Blood routine and liver and kidney function. At the end of the experiment, the animals were sacrificed, and the liver tissues of the right anterior lobe were taken for pathological sections, and H-E staining was used to observe the infiltration of inflammatory cells.
The results of the study:
In the control group and the low temperature group, each pig was overloaded with excessive blood loss and died second days after the operation. All the other animals were excluded. All the other animals survived to seventh days after the operation. During the experiment, the amount of blood loss in the control group and the low temperature group, the time of the detection of the heart rate and the arterial pressure were not significantly different, after the different intervention methods 2H. The liver temperature of C group and H group decreased by 1.17 + 0.68 and 2.08 + 0.21 C respectively. The difference between the two groups was statistically significant (P=0.020). The temperature of two groups in the same period was 0.93 + 0.83 and 0.48 + 0.75, respectively, and the difference was not statistically significant (P=0.40). The difference between log (AST) and P=0.016 at fifth days was significant, and the difference was significant after 2 hours of log (AST) perfusion. The pathological section showed that the degree of inflammation of liver inflammatory cells in the hypothermia group was significantly lighter than that of the control group.
The conclusions are as follows:
Biliary perfusion of 4 degrees C low temperature liquid can reduce the inflammatory reaction of the wounded liver, and is conducive to the recovery of liver function, thereby protecting the liver.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R657.3

【参考文献】