本文關(guān)鍵詞： 腹腔間隔室綜合征 新西蘭兔 二氧化碳分壓 氧分壓 腎功能 存活率　出處：《河北醫(yī)科大學(xué)》2008年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的:本研究旨在制作腹腔間隔室綜合征(abdominal compartment syndrome, ACS)動物模型的基礎(chǔ)上,通過觀察動脈血二氧化碳分壓及氧分壓,腎功能及存活率,探討腹腔間隔室綜合征時剖腹減壓術(shù)和腹腔穿刺引流減壓術(shù)的療效。 方法:實驗選用健康成年新西蘭兔33只,體質(zhì)量2.5～3.0kg,雌雄不限,購于河北醫(yī)科大學(xué)實驗動物中心。實驗分為正常對照組(3只)和實驗組(30只)。首先,制作簡易腹內(nèi)壓(IAP)測定計:從一次性輸液器剪下40cm左右長度輸液管,保留有過濾器一端并與三通管相連;拔下臺式血壓計與袖帶之間的連接管,將輸液管另一端連接至血壓計。其次,制作ACS動物模型:實驗組動物實驗前晚禁食、禁水。以2%戊巴比妥鈉,30 mg/kg耳緣靜脈注射麻醉后,仰臥位置于手術(shù)臺上,四肢固定,胸腹部剪毛、消毒,于下腹部正中線旁以16G留置套管針穿刺至腹腔,固定,將三通管連接至氮氣緩沖袋,緩慢持續(xù)增加入腹氣體量,之后將三通管連接至簡易IAP測定計,測定其壓力,并維持IAP為30 mmHg持續(xù)2小時,連續(xù)動態(tài)腹內(nèi)壓力監(jiān)測。ACS動物模型制成后隨機分為:剖腹減壓術(shù)組和腹腔穿刺引流減壓術(shù)組。剖腹減壓術(shù)組:將制作好的動物模型常規(guī)消毒、鋪巾。手術(shù)暴露腹腔,將腹腔內(nèi)氣體排出后,清理腹腔,清點器械、紗布、針線無誤后,縫合、包扎,術(shù)畢。腹腔穿刺引流減壓術(shù)組:將氮氣緩沖袋由三通管連接處取下,將三通管轉(zhuǎn)向與外界相通,持續(xù)腹腔減壓至正常腹內(nèi)壓。標(biāo)本采集:正常對照組分別抽取動、靜脈血樣標(biāo)本。實驗組血樣標(biāo)本采集分別于腹腔加壓2小時后及減壓治療后2小時。于兔耳中央動脈采集動脈血標(biāo)本2ml動脈血,檢測動脈血二氧化碳分壓(PCO2)及氧分壓(PO2)。于兔耳緣靜脈采集靜脈血標(biāo)本3ml,于普通試管中檢測腎功能(Cr、BUN)。比較ACS組和對照組及不同治療組的PCO2、PO2、Cr、BUN,同時比較不同治療組的存活率,以探討ACS動物模型基礎(chǔ)上,剖腹減壓術(shù)與腹腔穿刺引流減壓術(shù)的療效。 結(jié)果: 1、動物模型:本研究設(shè)計的動物模型制作方法簡便易行,費用低,致傷效果明顯,克服了以往實驗所采用動物模型的缺點。2、ACS組和對照組PCO2、PO2、Cr、BUN的變化:ACS組PCO2、Cr、BUN分別為(46.0±2.85)mmHg、(208.19±9.61)μmol/L、(12.29±0.66)mmol/L均顯著高于正常對照組(38.63±2.24)mmHg、(104.70±9.86)μmol/L、(6.63±0.61)mmol/L(P0.01);PO2為(76.18±3.62)mmHg較對照組(97.63±1.04)mmHg顯著降低(P0.01)。3、不同治療組PCO2、PO2、Cr、BUN的變化:腹腔穿刺引流減壓術(shù)組PCO2、Cr、BUN分別為(36.68±2.92)mmHg、(125.36±5.54)μmol/L、(7.08±0.39)mmol/L,較剖腹減壓術(shù)組(41.7±2.52)mmHg、(145.3±6.59)μmol/L、(8.30±0.46)mmol/L顯著降低(P0.05～P0.01);PO2為(94.12±3.0)mmHg顯著高于剖腹減壓術(shù)組(88.53±3.53)mmHg(P0.01)。兩者與治療前ACS組相比均明顯改善,具有統(tǒng)計學(xué)意義(P0.05～P0.01)。4、存活率:腹腔穿刺引流減壓術(shù)組成活率為93.33%,顯著高于剖腹減壓術(shù)組60.0%(X2=4.658,P=0.031)。 結(jié)論: 1、ACS動物模型具有制作簡單,壓力維持恒定,操作簡單等特點。同時其致傷效果明顯,表現(xiàn)為與正常對照組相比,ACS組氧分壓下降和二氧化碳分壓、血清肌酐、尿素氮升高。2、ACS早期腹腔減壓治療可明顯改善急性呼吸功能不全和急性腎功能不全,表現(xiàn)為腹腔減壓治療后氧分壓的升高和二氧化碳分壓、血清肌酐、尿素氮的回落。提示早期腹腔減壓對于ACS的重要性。同時,比較腹腔減壓的兩種方法,腹腔穿刺引流減壓術(shù)較剖腹減壓術(shù)更優(yōu)越,表現(xiàn)為腹腔穿刺引流減壓術(shù)各項指標(biāo)的改善較剖腹減壓術(shù)更明顯,且不需要較大腹部手術(shù),減少了較大手術(shù)所帶來的各種病理生理損害。
[Abstract]:Objective: This study aimed to abdominal compartment syndrome (abdominal compartment syndrome, making ACS) based on animal models, by observing the partial pressure of arterial carbon dioxide partial pressure of oxygen, renal function and survival rate of syndrome when laparotomy decompression and abdominal drainage decompression effect of abdominal compartment.
Methods: Twenty healthy adult New Zealand rabbits 33, weight 2.5 ~ 3.0kg, male or female, purchased from the experimental animal center of Hebei Medical University. The experiment was divided into normal control group (3 rats) and experimental group (30 rats). First of all, making simple intra-abdominal pressure (IAP) meter: from a transfusion device cut about 40cm length of the infusion tube, one end of the filter is retained and is connected with the three way pipe; connecting pipe between unplug the sphygmomanometer cuff and the transfusion pipe, the other end connected to a blood pressure meter. Secondly, making the animal model of ACS: experimental group of animal experiments before fasting, water deprivation. With 2% pentobarbital sodium anesthesia 30 mg/kg ear vein injection after supine position on the operating table, fixed limbs, chest and abdomen shearing, disinfection, in midline abdominal side by 16G trocar puncture to the abdominal cavity, fixed, three pipe connected to the nitrogen buffer bag, slowly increasing with abdominal gas volume, after the Three way pipe connected to a simple IAP meter, measuring pressure, and maintained IAP 30 mmHg for 2 hours, continuous dynamic monitoring of.ACS made animal model of intra-abdominal pressure after decompression were randomly divided into laparotomy group and abdominal drainage decompression group. Laparotomy decompression group: routine disinfection, animal model making good drape. Abdominal surgical exposure, the intraperitoneal gas discharged after cleaning, abdominal cavity, inventory of equipment, sewing gauze, correct, dressing, suture, postoperative abdominal drainage decompression group. The nitrogen buffer bags by three pipe joints removed, three steering pipe is communicated with the outside world, sustained abdominal decompression to normal IAP. Specimen collection: normal control group were selected, vein blood samples. Samples were collected from the abdominal pressure after 2 hours and 2 hours after decompression. In rabbit central ear artery blood 2ml arterial blood, detection Arterial partial pressure of carbon dioxide (PCO2) and oxygen partial pressure (PO2) in rabbit ear vein blood samples were collected from 3ml, ordinary test tube detection of renal function (Cr, BUN). Compared with ACS group and control group and PCO2 treatment group, different PO2, Cr, BUN, and the comparison of different treatment groups the survival rate, to explore the animal model of ACS based on abdominal decompression and abdominal drainage decompression effect.
緇撴灉: 1,鍔ㄧ墿妯″瀷:鏈爺絀惰璁＄殑鍔ㄧ墿妯″瀷鍒朵綔鏂規(guī)硶綆，

本文編號：1511414