腹腔间隔室综合征的动物模型制作及治疗
发布时间：2018-02-14 19:16
本文关键词： 腹腔间隔室综合征 新西兰兔 二氧化碳分压 氧分压 肾功能 存活率 出处：《河北医科大学》2008年硕士论文 论文类型：学位论文
【摘要】： 目的:本研究旨在制作腹腔间隔室综合征(abdominal compartment syndrome, ACS)动物模型的基础上,通过观察动脉血二氧化碳分压及氧分压,肾功能及存活率,探讨腹腔间隔室综合征时剖腹减压术和腹腔穿刺引流减压术的疗效。 方法:实验选用健康成年新西兰兔33只,体质量2.5～3.0kg,雌雄不限,购于河北医科大学实验动物中心。实验分为正常对照组(3只)和实验组(30只)。首先,制作简易腹内压(IAP)测定计:从一次性输液器剪下40cm左右长度输液管,保留有过滤器一端并与三通管相连;拔下台式血压计与袖带之间的连接管,将输液管另一端连接至血压计。其次,制作ACS动物模型:实验组动物实验前晚禁食、禁水。以2%戊巴比妥钠,30 mg/kg耳缘静脉注射麻醉后,仰卧位置于手术台上,四肢固定,胸腹部剪毛、消毒,于下腹部正中线旁以16G留置套管针穿刺至腹腔,固定,将三通管连接至氮气缓冲袋,缓慢持续增加入腹气体量,之后将三通管连接至简易IAP测定计,测定其压力,并维持IAP为30 mmHg持续2小时,连续动态腹内压力监测。ACS动物模型制成后随机分为:剖腹减压术组和腹腔穿刺引流减压术组。剖腹减压术组:将制作好的动物模型常规消毒、铺巾。手术暴露腹腔,将腹腔内气体排出后,清理腹腔,清点器械、纱布、针线无误后,缝合、包扎,术毕。腹腔穿刺引流减压术组:将氮气缓冲袋由三通管连接处取下,将三通管转向与外界相通,持续腹腔减压至正常腹内压。标本采集:正常对照组分别抽取动、静脉血样标本。实验组血样标本采集分别于腹腔加压2小时后及减压治疗后2小时。于兔耳中央动脉采集动脉血标本2ml动脉血,检测动脉血二氧化碳分压(PCO2)及氧分压(PO2)。于兔耳缘静脉采集静脉血标本3ml,于普通试管中检测肾功能(Cr、BUN)。比较ACS组和对照组及不同治疗组的PCO2、PO2、Cr、BUN,同时比较不同治疗组的存活率,以探讨ACS动物模型基础上,剖腹减压术与腹腔穿刺引流减压术的疗效。 结果: 1、动物模型:本研究设计的动物模型制作方法简便易行,费用低,致伤效果明显,克服了以往实验所采用动物模型的缺点。2、ACS组和对照组PCO2、PO2、Cr、BUN的变化:ACS组PCO2、Cr、BUN分别为(46.0±2.85)mmHg、(208.19±9.61)μmol/L、(12.29±0.66)mmol/L均显著高于正常对照组(38.63±2.24)mmHg、(104.70±9.86)μmol/L、(6.63±0.61)mmol/L(P0.01);PO2为(76.18±3.62)mmHg较对照组(97.63±1.04)mmHg显著降低(P0.01)。3、不同治疗组PCO2、PO2、Cr、BUN的变化:腹腔穿刺引流减压术组PCO2、Cr、BUN分别为(36.68±2.92)mmHg、(125.36±5.54)μmol/L、(7.08±0.39)mmol/L,较剖腹减压术组(41.7±2.52)mmHg、(145.3±6.59)μmol/L、(8.30±0.46)mmol/L显著降低(P0.05～P0.01);PO2为(94.12±3.0)mmHg显著高于剖腹减压术组(88.53±3.53)mmHg(P0.01)。两者与治疗前ACS组相比均明显改善,具有统计学意义(P0.05～P0.01)。4、存活率:腹腔穿刺引流减压术组成活率为93.33%,显著高于剖腹减压术组60.0%(X2=4.658,P=0.031)。 结论: 1、ACS动物模型具有制作简单,压力维持恒定,操作简单等特点。同时其致伤效果明显,表现为与正常对照组相比,ACS组氧分压下降和二氧化碳分压、血清肌酐、尿素氮升高。2、ACS早期腹腔减压治疗可明显改善急性呼吸功能不全和急性肾功能不全,表现为腹腔减压治疗后氧分压的升高和二氧化碳分压、血清肌酐、尿素氮的回落。提示早期腹腔减压对于ACS的重要性。同时,比较腹腔减压的两种方法,腹腔穿刺引流减压术较剖腹减压术更优越,表现为腹腔穿刺引流减压术各项指标的改善较剖腹减压术更明显,且不需要较大腹部手术,减少了较大手术所带来的各种病理生理损害。
[Abstract]:Objective: This study aimed to abdominal compartment syndrome (abdominal compartment syndrome, making ACS) based on animal models, by observing the partial pressure of arterial carbon dioxide partial pressure of oxygen, renal function and survival rate of syndrome when laparotomy decompression and abdominal drainage decompression effect of abdominal compartment.
Methods: Twenty healthy adult New Zealand rabbits 33, weight 2.5 ~ 3.0kg, male or female, purchased from the experimental animal center of Hebei Medical University. The experiment was divided into normal control group (3 rats) and experimental group (30 rats). First of all, making simple intra-abdominal pressure (IAP) meter: from a transfusion device cut about 40cm length of the infusion tube, one end of the filter is retained and is connected with the three way pipe; connecting pipe between unplug the sphygmomanometer cuff and the transfusion pipe, the other end connected to a blood pressure meter. Secondly, making the animal model of ACS: experimental group of animal experiments before fasting, water deprivation. With 2% pentobarbital sodium anesthesia 30 mg/kg ear vein injection after supine position on the operating table, fixed limbs, chest and abdomen shearing, disinfection, in midline abdominal side by 16G trocar puncture to the abdominal cavity, fixed, three pipe connected to the nitrogen buffer bag, slowly increasing with abdominal gas volume, after the Three way pipe connected to a simple IAP meter, measuring pressure, and maintained IAP 30 mmHg for 2 hours, continuous dynamic monitoring of.ACS made animal model of intra-abdominal pressure after decompression were randomly divided into laparotomy group and abdominal drainage decompression group. Laparotomy decompression group: routine disinfection, animal model making good drape. Abdominal surgical exposure, the intraperitoneal gas discharged after cleaning, abdominal cavity, inventory of equipment, sewing gauze, correct, dressing, suture, postoperative abdominal drainage decompression group. The nitrogen buffer bags by three pipe joints removed, three steering pipe is communicated with the outside world, sustained abdominal decompression to normal IAP. Specimen collection: normal control group were selected, vein blood samples. Samples were collected from the abdominal pressure after 2 hours and 2 hours after decompression. In rabbit central ear artery blood 2ml arterial blood, detection Arterial partial pressure of carbon dioxide (PCO2) and oxygen partial pressure (PO2) in rabbit ear vein blood samples were collected from 3ml, ordinary test tube detection of renal function (Cr, BUN). Compared with ACS group and control group and PCO2 treatment group, different PO2, Cr, BUN, and the comparison of different treatment groups the survival rate, to explore the animal model of ACS based on abdominal decompression and abdominal drainage decompression effect.
缁撴灉: 1,鍔ㄧ墿妯″瀷:鏈爺绌惰璁＄殑鍔ㄧ墿妯″瀷鍒朵綔鏂规硶绠，
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