本文選題：腹腔高壓 + 腹腔間隔室綜合征��； 參考：《南京大學(xué)》2013年碩士論文

【摘要】：第一部分腹腔高壓對低血容量家豬血流動力學(xué)及腦灌注的影響 [摘要]目的探討不同程度腹腔高壓(IAH)對低血容量家豬血流動力學(xué)及腦灌注的影響。方法選擇實驗家豬40只,經(jīng)頸動脈釋放家豬30%血容量,維持家豬低血容量狀態(tài),按隨機(jī)數(shù)字表法將家豬隨機(jī)分為四組(IAPL0、IAPL15、IAPl25和IAPL35組),采用氮氣(N2)氣腹法分別維持IAP為0、15、25和35mmHg即IAPL0組、IAPL15組、IAPL25組和IAPL35組,穩(wěn)定30min后采用脈搏輪廓連續(xù)心排血量監(jiān)測(PiCCO)法監(jiān)測各組家豬心率(HR)、平均動脈壓(MAP)、中心靜脈壓(CVP)、心排血量(CO)、全心舒張末期容積指數(shù)(GEDVI)和每搏輸出量指數(shù)(SVI)等血流動力學(xué)指標(biāo),腦室內(nèi)置入顱內(nèi)壓光纖探頭,連接顱內(nèi)壓監(jiān)測儀連續(xù)監(jiān)測顱內(nèi)壓(ICP),計算腦灌注壓(CPP)。結(jié)果(1)與IAPLo組比較,IAPL15、IAPL25和工APL35組均表現(xiàn)為HR增快,GEDVI和SVI降低,SVRI增加,CVP升高(P均0.05),且各腹腔高壓組(IAPL155、IAPL25 和IAPL35組)間比較差異均具有統(tǒng)計學(xué)意義(P均0.05)；與IAPL0組比較,IAPL15組MAP增加(P0.05),而IAPL25組和IAPL35組MAP無明顯變化(P0.05),IAPL15組CI無明顯變化(P＞0.05),而IAPL25組和IAPL35組CI則顯著下降(P0.05)；EVLWI各組間比較均無顯著差異(P0.05)；(2)與IAPLo組比較,IAPL15組ICP無明顯變化(P＞0.05),IAPL25和IAPL35組ICP均明顯增加(P0.05), IAPL15、IAPL25和IAPL35組CPP均無明顯變化(P＞0.05)；與IAPu5組比較,IAPL25和IAPL35組CPP均顯著降低(P0.05)。結(jié)論腹腔高壓可以導(dǎo)致心排血量減少,顱內(nèi)壓升高,腦灌注減少,并且腹腔壓力越高,影響越顯著。 第二部分液體復(fù)蘇對腹腔高壓家豬血流動力學(xué)及腦灌注的影響 [摘要]目的探討液體復(fù)蘇對低血容量的腹腔高壓家豬血流動力學(xué)及腦灌注的影響。方法選擇實驗家豬40只,經(jīng)頸動脈釋放家豬30%血容量,維持家豬低血容量狀態(tài),按隨機(jī)數(shù)字表法隨機(jī)分為四組(IAPLo組、IAPL15組、IAPL25組和IAP-5組),采用氮氣氣腹法分別維持IAP為0、15、25和35mmHg即IAPLo組、IAPL15組、IAPL25組和IAPL35組,各組均穩(wěn)定30min后快速靜脈輸注羥乙基淀粉500ml進(jìn)行液體復(fù)蘇,采用PiCCO法分別于復(fù)蘇前及復(fù)蘇后30min監(jiān)測各組家豬HR、MAP、CVP、CI、GEDVI和SVI等血流動力學(xué)指標(biāo),腦室內(nèi)置入顱內(nèi)壓光纖探頭,連接顱內(nèi)壓監(jiān)測儀連續(xù)監(jiān)測ICP變化,計算CPP。結(jié)果(1)IAPL。組、IAPL15組、IAP-5組和IAPL35組經(jīng)液體復(fù)蘇后均表現(xiàn)為HR下降,MAP升高,CI、GEDVI和SVI增加(P均0.05),CVP則無明顯變化(P＞0.05),IAPL15組、IAPL25組和IAPL35組SVRI顯著下降(P均0.05)；各組EVLWI無明顯變化(P均0.05)；(2)IAPLo組、IAPL15組、IAP-5組和IAPL35組,液體復(fù)蘇后ICP均顯著升高(P均0.05),IAPL25和IAPL35組CPP亦顯著增加(P均0.05),而IAPL15組CPP無明顯變化(P0.05)。結(jié)論腹腔高壓時,液體復(fù)蘇可以增加低血容量家豬的心排血量,改善家豬循環(huán)狀態(tài),但有增加顱內(nèi)壓的風(fēng)險。第三部分每搏輸出量變異評價腹腔高壓家豬液體反應(yīng)性的實驗研究[摘要]目的探討每搏輸出量變異(SVV)評價腹腔高壓家豬液體反應(yīng)性的準(zhǔn)確性以及不同程度腹腔高壓對其準(zhǔn)確性的影響。方法選擇實驗家豬40只,經(jīng)頸動脈釋放家豬30%血容量,維持家豬低血容量狀態(tài),并按隨機(jī)數(shù)字表法隨機(jī)分為四組(IAPL0組、IAPL15組、IAPL25組和IAPL35組),采用氮氣氣腹法分別維持IAP為0、15、25和35mmHg即IAPL0組、IAPL15組、IAPL25組和IAPL35組,穩(wěn)定30min后均給予羥乙基淀粉500ml快速靜脈滴注進(jìn)行液體復(fù)蘇,采用PiCCO法分別于復(fù)蘇前及復(fù)蘇后30min監(jiān)測各組家豬SVV、CVP、CO、GEDVI、SVI等血流動力學(xué)指標(biāo)的變化。將液體復(fù)蘇前、后每搏輸出量變化(ΔSV%)≥15%定義為液體有反應(yīng)。結(jié)果(1)與IAPLo組比較,IAPL15、IAPL25和IAPLa5組SVV均顯著增加(P0.05)；與IAPL15組相比,IAPL25組SVV無明顯變化(P＞0.05),IAPL35組SVV顯著增加(P0.05)；(2)液體復(fù)蘇后,IAPL0組SVV顯著降低(P0.05),而IAPL15、IAPL25和IAPL35組均無明顯變化(P＞0.05)；(3)IAPL0、IAPL15、IAPL25和IAP-5組CVP與ΔSV%均無顯著相關(guān)性(r分別為0.205、-0.161、-0.24和0.217,P均0.05)；(4)IAPL0和IAPL15組家豬SVV與△SV%呈顯著正相關(guān)(r分別為0.888和0.942,P0.05),而IAPL25和IAPL35組SVV與ASV%均無明顯相關(guān)性(r分別為0.851和-0.114,P＞0.05)。結(jié)論腹腔壓力輕度升高時(IAP≤15mmHg)SW可有效預(yù)測液體反應(yīng)性,而重度腹腔高壓時SVV不能準(zhǔn)確預(yù)測液體反應(yīng)性,需進(jìn)一步探討其影響因素。
[Abstract]:Effects of the first part of abdominal pressure on the flow dynamics and cerebral perfusion in swine with low blood volume

Objective To investigate the effects of different degrees of intraperitoneal high pressure ( IAH ) on the flow dynamics and cerebral perfusion in swine with low blood volume . Methods : Forty healthy pigs were randomly divided into four groups ( IAPL0 , IAPL15 , IAPl25 and IAPL35 ) by using nitrogen ( N2 ) methods . Results ( 1 ) Compared with the IAPLo group , the patients with IAPL15 , IAPL25 , and APL35 were randomly divided into four groups ( IAPL0 , IAPL25 , and IAPL35 ) . The results showed that the ratio of GEDVI and SVI decreased , SVRI increased , CVP increased ( P < 0.05 ) , and the IPL15 , IAPL25 and IAPL25 groups were divided into four groups : IAPL155 , IAPL25 and IAPL25 .

Compared with the IAPL35 group , the difference was statistically significant ( P < 0.05 ) .
Compared with the IAPL0 group , the MAP of IAPL15 group increased ( P0.05 ) , but there was no significant change in MAP in IAPL25 group and IAPL35 group ( P0.05 ) , but CI in IAPL25 group and IAPL35 group decreased significantly ( P0.05 ) .
There was no significant difference between EVLWI and EVLWI ( P0.05 ) .
( 2 ) Compared with the IAPLo group , there was no significant change in ICP in IAPL15 group ( P > 0.05 ) , ICP in IAPL25 and IAPL35 group was significantly increased ( P0.05 ) , there was no significant change in CPP in IAPL15 , IAPL25 and IAPL35 group ( P > 0.05 ) ;
Compared with IAPu5 group , the CPP in IAPL25 and IAPL35 group decreased significantly ( P0.05 ) . Conclusion Abdominal high pressure can result in the decrease of cardiac output , the increase of intracranial pressure , the decrease of cerebral perfusion , and the higher the abdominal pressure , the more significant the effect is .

Effects of the second part of liquid resuscitation on the flow dynamics and cerebral perfusion of swine in abdominal cavity

Objective To investigate the effects of liquid resuscitation on hemodynamics and cerebral perfusion in abdominal high pressure patients with low blood volume . The results showed that 40 rats were randomly divided into four groups ( IAPLo group , IAPL15 group , IAPL25 group and IAP - 5 group ) by using nitrogen gas - abdominal method . The results showed that the HR , MAP , CVP , CI , GEDVI and SVI were all stable in group IAPL15 , IAPL25 and IAPL . Results ( 1 ) There was no significant change in the MAP , CI , GEDVI and SVI ( P > 0.05 ) , and the SVRI in IAPL15 , IAPL25 and IAPL35 groups decreased significantly ( P < 0.05 ) .
There was no significant change in EVLWI in each group ( P < 0.05 ) .
The results ( 1 ) were compared with the group of IAPL0 group , IAPL15 group , IAPL25 group and IAPL35 group . Results ( 1 ) Compared with the IAPLo group , the IAPL15 , IAPL25 and IAPLa5 groups increased significantly ( P0.05 ) .
Compared with the IAPL15 group , the IAPL25 group had no significant change ( P > 0 . 05 ) , and that of the IAPL35 group was significantly increased ( P0.05 ) .
( 2 ) After resuscitation , the IAPL0 group decreased significantly ( P0.05 ) , but there was no significant change in IAPL15 , IAPL25 and IAPL35 groups ( P > 0.05 ) .
( 3 ) There was no significant correlation between CVP and 螖SV % in IAPL0 , IAPL15 , IAPL25 and IAP - 5 ( r = 0.205 , - 0.161 , - 0.24 and 0.217 , P < 0.05 ) .
( 4 ) There was a significant positive correlation between IAPL0 and IAPL15 ( r = 0.888 and 0.942 , P0.05 ) , but there was no significant correlation between IAPL25 and IAPL35 group ( r = 0.851 and - 0.114 , P > 0.05 ) . Conclusion When the abdominal pressure is slightly elevated ( IAP 鈮，

本文編號：1929258