摘要目的 评价腹腔高压状态对急性坏死性胰腺炎模型猪血流动力学的影响.方法 在12只家猪胰管内注射含5%牛磺胆酸钠和0.5%胰蛋白酶的生理盐水1 ml/kg,制作急性坏死性胰腺炎模型.模型随机分为两组(n=6),一组采用氮气气腹法制作30 mmHg(1 mmHg=0.133 kPa)腹腔高压模型,持续12 h(腹腔高压组);另一组未暴露于腹腔高压(胰腺炎组).利用动脉导管和血流导向气囊导管动态监测平均动脉压、心排血量、中心静脉压、肺动脉压、肺动脉楔压等血流动力学指标并行血气分析检查.观察腹腔高压对胰腺炎猪血流动力学的影响.结果 腹腔高压组1只猪在造模后11 h死亡,另11只持续观察12 h.与胰腺炎组相比,腹腔高压组在3、6和12 h时,心率、中心静脉压、平均肺动脉压和肺动脉楔压上升;12 h时心排血量、平均动脉压明显下降(P均<0.05).制模前两组气道峰压无差异,制模后腹腔高压组气道峰压在6 h和12 h时分别达(50.2±3.1)cmH2O(1 cmH2P=0.098 kPa)和(49.8±0.9)cmH2O,明显高于胰腺炎组(P<0.01).腹腔高压组6 h和12 h时的pH值、氧分压、中心静脉血氧饱和度及碱剩余较胰腺炎组明显下降,血乳酸和二氧化碳分压则明显上升(P均<0.05).结论 腹腔高压对急性坏死性胰腺炎模型猪的血流动力学产生明显影响,及时采用合适的方式减轻、解除腹腔高压是胰腺炎治疗的重要环节之一.

abstractsObjective To assess the effect of infra-abdominal hypertension (IAH) on hemodynamics of severe acute pancreatitis (SAP) in porcine model. Methods Following baseline registrations, SAP was induced in 12 animals. The N2 pneumoperitoneum was used to increase the intra-abdominal pressure to 30 mmHg (1 mmHg = 0. 133 kPa) in 6 of 12 SAP animals thereafter and keep constant during the experiment. The investigation period was 12 h. Heart rate, cardiac output (CO), central venous pressure (CVP) , mean arterial pressure and pulmonary arterial wedge pressure (PAWP)were continuously measured with the aid of balloon tipped flow-directed catheter and electrocardiography monitor. Oxygen partial pressure of artery (PaO2) , carbon dioxide partial pressure of artery (PaCO2) , ScvO2, base excess (BE) , and blood lactic acid (LAC) were measured by acid-base analysis. Results In the IAH group, CO decreased significantly at 12 h, CVP and PAWP increased significantly at 3 h, 6 h and 12 h compared with SAP group (all P < 0. 05). Peak inspiration pressure increased immediately after pneumoperitoneum in the IAH group, to (50. 2±3. 1) cmH2O(1 cmH2O =0. 098 kPa) and (49. 8±0. 9) cmH2O at 6 h and 12 h respectively. The pH, PaO2, ScvO2 and BE showed a tendency to fall in the IAH group. PaCO2 and LAC were increased significantly in the IAH group (all P < 0. 05). Conclusions There were remarkable and relatively irreversible effects on global hemodynamics in response to sustained IAH of 12 h with the underlying condition of SAP. Abdominal decompression is beneficial for patients of SAP with IAH.