本文選題：側(cè)流暗場(chǎng)成像 + 微循環(huán)��； 參考：《中國(guó)病理生理雜志》2017年04期

【摘要】：目的:利用側(cè)流暗場(chǎng)(sidestream dark-field,SDF)成像技術(shù)觀察比較內(nèi)毒素休克兔經(jīng)液體復(fù)蘇至同一目標(biāo)血壓水平下小腸絨毛微循環(huán)及舌下微循環(huán)變化的異同。方法:新西蘭大白兔60只,隨機(jī)分為絨毛組及舌下組,每組30只。2組均行體外回腸造口術(shù),用細(xì)菌脂多糖注射建立內(nèi)毒素休克模型。建模成功后用乳酸林格氏液以復(fù)蘇劑量30 mL·kg~(-1)·h~(-1)進(jìn)行液體復(fù)蘇使平均動(dòng)脈壓(MAP)達(dá)到80 mmHg為目標(biāo)血壓。若經(jīng)單純液體復(fù)蘇,血壓仍不能達(dá)標(biāo)者,則予以去甲腎上腺素0.5~1μg·kg~(-1)·min~(-1)維持至目標(biāo)血壓。通過(guò)SDF成像技術(shù)持續(xù)觀察2組動(dòng)物休克前后以及液體復(fù)蘇后的小腸絨毛及舌下微循環(huán)灌注指標(biāo):絨毛血管數(shù)量(vessels per villus,VV)、微血管血流指數(shù)(microvascular flow index,MFI)、灌注絨毛比例(proportion of perfused villi,PPVi)、絨毛邊界量化評(píng)分、絨毛血管評(píng)分、總的血管密度(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)等的變化并比較兩者灌注特點(diǎn)的異同。結(jié)果:休克后,小腸絨毛MFI、PPVi以及舌下微循環(huán)MFI、PPVe、TVD、PVD較休克前均顯著下降(P0.01),其中小腸絨毛微循環(huán)MFI顯著低于舌下微循環(huán)(P0.01);經(jīng)液體復(fù)蘇至MAP達(dá)到目標(biāo)血壓后,小腸絨毛MFI、PPVi以及舌下微循環(huán)MFI、PPVe、TVD、PVD較休克后均有明顯上升(P0.05),但復(fù)蘇后的小腸絨毛微循環(huán)MFI仍明顯低于舌下微循環(huán)(P0.01)。結(jié)論:內(nèi)毒素休克兔小腸絨毛與舌下微循環(huán)灌注變化有差異,休克后小腸絨毛微循環(huán)灌注下降程度較舌下微循環(huán)更顯著,而液體復(fù)蘇后小腸絨毛微循環(huán)灌注恢復(fù)程度亦低于舌下微循環(huán)。
[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.
【作者單位】： 遵義醫(yī)學(xué)院附屬醫(yī)院重癥醫(yī)學(xué)科;
【基金】：國(guó)家自然科學(xué)基金資助項(xiàng)目(No.81560308) 貴州省科學(xué)技術(shù)基金資助項(xiàng)目(黔科合J字[2010]2180號(hào))
【分類(lèi)號(hào)】：R459.7

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