摘要目的 通过制作腹腔高压液体动物模型,探索腹腔间隔室综合症肺脏、胰腺、肾脏的病理变化.方法 将20只新西兰兔按随机数字表法分为3组,对照组4只,实验1组8只,实验2组8只,分别制作腹腔高压液体动物模型,对照组加压水囊不注液,维持压力为0 mmHg(0 Kpa),时限48 h;实验1组和2组每注入50 ml生理盐水时记录腹腔压力和增容量,绘制腹腔压力-增容量曲线,实验组压力均调节在22 mmHg(2.96 Kpa),实验1组时限24 h,实验2组时限48 h.到达观察时限即刻处死实验动物,完整切取肺脏/胰腺和肾脏,用10％甲醛溶液固定24 h后常规石蜡包埋,切片,HE染色,在生物光学显微镜下观察.结果 实验过程中,对照组4只均存活,实验1组死亡1只,实验2组死亡2只.实验组腹腔高压液体动物模型腹腔压力与腹腔增容量存在正相关关系,函数方程:Y=0.1486X-119.0000(R2=0.827 4,P=0.004 5).观察3组实验动物肺脏病理变化,对照组:正常肺脏内可见终末细支气管和大量肺泡,间质内小血管扩张;实验1组:肺泡上皮增生,肺泡间隔大小不一,小灶肺泡腔融合,肺泡组织间出血,可见暗褐色物质沉积,血管内血栓,可见机化再通;实验2组:肺泡明显扩张,部分肺泡腔融合,肺泡间隔不一,终末细支气管腔内可见大量红细胞及纤维素样渗出物,其中有暗褐色物质沉积.观察3组实验动物胰腺病理变化,对照组:腺泡由一层椎体腺泡细胞组成,细胞核圆形,靠近细胞基部,核仁明显,基部胞质由于内富含粗面内质网和核糖体而呈嗜碱性:实验1组:胰腺腺泡变性,胰腺组织内大量炎细胞浸润,淋巴窦扩张,窦内充满淋巴液,淋巴管水肿,胰腺旁淋巴结,淋巴窦扩张,窦内皮细胞增生,淋巴组织增生;实验2组:胰腺腺泡明显变性,胰腺间质内血管扩张充血,胰腺组织内淋巴管扩张,内含大量淋巴液.观察3组实验动物肾脏病理变化,对照组:肾小球及血管基本正常,肾小管轻度扩张;实验1组:肾小球系膜细胞节段性轻度增生,系膜基质轻度增宽,肾小管扩张,内可见蛋白管型,肾小管上皮细胞颗粒样变性,间质内血管扩张充血;实验2组:肾小球节段性增生,肾小管上皮细胞水肿,肾小管扩张,管腔内可见蛋白管型,肾间质小血管可见扩张、充血.结论 腹腔间隔室综合症发展过程中,肺脏、胰腺和肾脏均出现明显的继发性损害,且随着时间延长而损害加重.

abstractsObjective To explore the pathological changes of lung,pancreas and kidney in abdominal compartment syndrome by making an animal model of abdominal hypertension.Methods 20 New Zealand rabbits were divided into 3 groups,4 in the control group,8 in the experiment group 1,and 8 in group 2.The control group were not injected with pressure water capsule,the pressure was 0 mmHg(0 Kpa),and the time limit was 48 hours.The pressure and increased volume of abdominal pressure was recorded each time of injection of 50 ml saline in group 1 and group 2.The abdominal pressure-volume curve was plotted.Then the pressure of the experimental group was adjusted to 22 mmHg(2.96 Kpa),and the time limit of experimental group 1 was 24 hours,the group 2 was 48 hours.The experimental animals were killed at the time of observation,the whole lung,pancreas and kidney were completed and fixed with 10％ Formaldehyde solution for 24 hours,and the routine paraffin was embedded,sliced,stained with HE,and observed under the biological optical microscope.Results During the experiment,4 of the control group survived,1 died in the experimental group 1,and 2 died in group 2.There was a positive correlation between abdominal pressure and increasing volume of abdominal cavity in the experimental group of abdominal high pressure liquid animal model.The function equation:Y=0.1486X-119.0000 (R2=0.827 4,P=0.004 5).Pathological changes of lungs in three groups of experimental animals:control group:terminal bronchioles and a large number of alveoli in normal lungs,interstitial small vessel dilatation.The group 1:alveolar epithelial hyperplasia,alveolar septum size,alveolar lumen fusion,alveolar interstitial bleeding,dark brown matter deposition,intravascular thrombus,and computerized recanalization.In the group 2,the alveoli were dilated obviously,some alveolar cavities were fused,the alveolar septum was not one,and a large number of red cells and cellulosic exudates were found in the terminal fine bronchioles,including dark brown matter deposition.Pathological changes of pancreas in the three groups:control group:acinus:acinar cell consists of a layer of vertebral acinar cells,the nucleus was round,close to the base of the cell,and the nucleolus was obvious;the basal cytoplasm was basophilic because of the rich in rough endoplasmic reticulum and ribosome.The group 1:pancreatic acinar degeneration,large number of inflammatory cells infiltrating in the pancreatic tissue,lymphatic sinus dilation,lymph nodes filled with lymph,lymphatic edema,paranantral lymph nodes,lymphatic sinus dilatation,sinus endothelial cell proliferation and lymphoid hyperplasia.In the group 2,the pancreatic acini were markedly degenerated,blood vessels were dilated and congested in the interstitium,and the lymphatic vessels in the pancreatic tissue expanded and contained large amounts of lymph.Pathological changes of kidney in three groups of experimental animals:control group:glomeruli and blood vessels were basically normal,and renal tubules were slightly dilated.The group 1:mild segmental hyperplasia of glomerular mesangial cells,mild enlargement of mesangial matrix,dilatation of renal tubules,internal protein tube type,granulosa like degeneration of renal tubular epithelial cells and dilatation and congestion of endoplasmic blood vessels.Experimental group 2:glomerular segmental hyperplasia,renal tubular epithelial cell edema,renal tubule dilatation,canalicular type in the lumen,small vessels of the renal interstitium dilated and hyperemia.Conclusion Lung,pancreas and kidney have obvious secondary damage at the development of abdominal compartment syndrome and aggravates with the extension of time.