本文選題：腹腔高壓　切入點(diǎn)：腹腔壓力　出處：《廣西醫(yī)科大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：建立大鼠腹腔高壓（Intra-abdominal hypertension, IAH）模型，觀察不同腹腔壓力（Intra-abdominal pressure, IAP）及持續(xù)不同時間對肝臟的影響，為進(jìn)一步研究IAH與多器官功能障礙關(guān)系作準(zhǔn)備，為臨床監(jiān)測IAP的頻率提供實(shí)驗(yàn)依據(jù)。 方法：通過往腹腔內(nèi)注入氮?dú)饨⒋笫驣AH模型；以一次性使用靜脈輸液針穿刺腹腔，連接一次性輸液器，通過三通管連接血壓計(jì)、氮?dú)鈨獯?0ml注射器。將45只健康雄性SD（Sprague-Dawley）大鼠，隨機(jī)分為對照組（15只）和模型組（30只）。模型組按不同IAP水平分為10mmHg組和20mmHg組，該兩組以IAP維持1h、2h和4h三個時間點(diǎn)再隨機(jī)分為三個組，每組5只SD大鼠。對照組僅行腹腔穿刺置針處理，不往腹腔內(nèi)注入氮?dú)�，亦隨機(jī)分為1h、2h和4h組。比較模型組初次達(dá)相應(yīng)IAP并穩(wěn)定30s不變時，氮?dú)庾⑷肓康淖兓�。所有大鼠達(dá)預(yù)定實(shí)驗(yàn)時間點(diǎn)時，迅速腹主動脈采血檢測血清AST、ALT的含量變化，并取肝右葉組織行組織病理學(xué)檢查。 結(jié)果：1.動物模型：本研究制作的大鼠IAH模型制作簡便，費(fèi)用低，IAP穩(wěn)定可靠，副作用少，克服了以往實(shí)驗(yàn)所采用的IAH動物模型的缺點(diǎn)。2.兩模型組大鼠質(zhì)量比較，差異無統(tǒng)計(jì)學(xué)意義（IAP10mmHg組:311.73±35.18g vs. IAP20mmHg組:295.67±19.99g，t=1.538，P＞0.05）。IAP20mmHg組大鼠腹腔內(nèi)氮?dú)庾⑷肓浚?46.87±14.25）ml明顯大于IAP10mmHg組（127.73±12.00）ml（t=3.978，P＜0.001）。3.IAP10mmHg4h組血清AST、ALT含量分別為（297.40±48.42）U/L、（173.60±73.67）U/L，均顯著高于IAP10mmHg1h組(169.40±47.69）U/L、（74.00±22.57）U/L（均P＜0.01）和IAP10mmHg2h組（223.40±61.78）U/L、（103.60±40.44）U/L（均P＜0.05）；但I(xiàn)AP10mmHg2h組與1h組比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。IAP20mmHg4h組血清AST、ALT含量分別為（398.80±83.35）U/L、（237.20±74.40）U/L，均顯著高于IAP20mmHg1h組（199.60±33.95）U/L、（81.40±30.53）U/L（均P＜0.01）和IAP20mmHg2h組（306.40±72.40）U/L、（154.20±42.03）U/L（均P＜0.05）；IAP20mmHg2h組血清AST、ALT含量與IAP20mmHg1h組相比，差異亦有統(tǒng)計(jì)學(xué)意義（均P＜0.05）。模型組IAP維持1h血清AST、ALT含量變化與對照組1h組比較，差異無統(tǒng)計(jì)學(xué)意義（均P＞0.05）。IAP維持2h血清AST、ALT含量變化：IAP20mmHg2h組血清AST、ALT含量分別為（306.40±72.40）U/L、（154.20±42.03）U/L，均顯著高于對照組2h組（158.00±33.92）U/L、（77.60±7.16）U/L （均P＜0.01）和IAP10mmHg2h組（223.40±61.78）U/L、（103.60±40.44）U/L（均P＜0.05）。IAP維持4h血清AST、ALT含量變化：IAP20mmHg4h組血清AST、ALT含量分別為（398.80±83.35）U/L、（237.20±74.40）U/L，與對照組4h組（160.80±21.30）U/L、（75.20±18.43）U/L比較，差異具有統(tǒng)計(jì)學(xué)意義（均P＜0.01），與IAP10mmHg4h組血清AST（297.40±48.42）U/L比較，差異亦有統(tǒng)計(jì)學(xué)意義（P＜0.05），但與IAP10mmHg4h組血清ALT（173.60±73.67）U/L比較，差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）；IAP10mmHg4h組血清AST、ALT含量與對照組4h組比較，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.01，P＜0.05）。4.肝組織病理形態(tài)學(xué)變化：IAP10mmHg4h組中央靜脈周邊少許肝細(xì)胞輕度濁腫變性，可見空泡變性，核腫脹，近中央靜脈區(qū)肝竇輕度擴(kuò)張、充血。IAP20mmHg1h組，肝小葉結(jié)構(gòu)清楚，中央靜脈周邊少許肝細(xì)胞輕度濁腫變性，排列稍紊亂，細(xì)胞邊界欠清晰，肝竇輕度充血；IAP20mmHg組隨IAP持續(xù)時間延長肝細(xì)胞損傷范圍增大。IAP20mmHg4h組，肝小葉結(jié)構(gòu)紊亂，可見肝細(xì)胞點(diǎn)狀壞死，少許炎癥細(xì)胞浸潤。 結(jié)論：1.成功制作了穩(wěn)定可靠的大鼠IAH動物模型，，本IAH模型制作、操作簡單，耗費(fèi)低，容易復(fù)制，對肝功能損傷效果明顯。2.IAP達(dá)一定程度時，較小的腹腔內(nèi)容積變化亦可引起較大的IAP變化。3.IAH可導(dǎo)致肝損傷，同一IAP，IAP持續(xù)時間越長，肝損傷越嚴(yán)重；同一作用時間，IAP越高，肝損傷越重。IAP10mmHg作用4h中央靜脈周邊少許肝細(xì)胞輕度水腫；IAP20mmHg作用1h可能已有輕度肝損傷，IAP20mmHg作用4h，可見肝細(xì)胞點(diǎn)狀壞死，少許炎癥細(xì)胞浸潤。
[Abstract]:Objective: to establish a rat model of intra-abdominal hypertension (Intra-abdominal, hypertension, IAH) model, to observe the effects of different intra-abdominal pressure (Intra-abdominal pressure, IAP) and the influence of different duration on the liver, preparing for the further study of the relationship between IAH and multiple organ dysfunction, and provide experimental basis for clinical monitoring of IAP frequency.
Methods: by intraperitoneal injection of gaseousnitrogen rat IAH model; the disposable intravenous infusion needle was connected with a disposable transfusion device, connected with a sphygmomanometer through three way pipe, nitrogen gas storage bag and 50ml syringe. A total of 45 healthy male SD (Sprague-Dawley) rats were randomly divided into control group (15) and the model group (30 rats). The model group according to different levels of IAP were divided into 10mmHg group and 20mmHg group, the two groups to maintain IAP 1H, 2h and 4H three time points and then randomly divided into three groups, each group had 5 SD rats. The control group was treated with abdominal puncture needle treatment, not to intraperitoneal injection of nitrogen, were also randomly divided into 1H, 2h and 4H group. The first group of IAP and the corresponding model is stable 30s unchanged, changes in the amount of nitrogen injection. All rats reached a predetermined experimental time point, rapid detection of serum AST abdominal aorta blood and the content of ALT, and the right lobe of the liver tissue histopathological Study.
Results: 1. animal model: the IAH rat model made of simple production, low cost, IAP is stable and reliable, less side effects, to overcome the disadvantages of IAH.2. quality group rats animal model was used in the experiments of the two models, the difference was not statistically significant (IAP10mmHg group: IAP20mmHg group: vs. 311.73 + 35.18g 295.67 + 19.99g, t=1.538, P > 0.05).IAP20mmHg rats intraperitoneal injection of nitrogen (146.87 + 14.25) ml was significantly higher than that of IAP10mmHg group (127.73 + 12) ml (t=3.978, P < 0.001) in.3.IAP10mmHg4h group serum AST, ALT were (297.40 + 48.42) U/L, (173.60 + 73.67) U/L, significantly higher than that of group IAP10mmHg1h (169.40 + 47.69) U/L, (74 + 22.57) U/L (P < 0.01) and IAP10mmHg2h group (223.40 + 61.78) U/L, (103.60 + 40.44) U/L (P < 0.05); but the IAP10mmHg2h group compared with the 1H group, there was no statistically significant difference (P > 0.05).IAP20mmHg4h group, serum AST, ALT 鍚噺鍒嗗埆涓

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