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[大鼠肾上腺下腔静脉结扎及右肾切除或注射川芎嗪后的心脏血流动力学]

[Cardiac hemodynamics after suprarenal ligation of the inferior vena cava and the resection of the right kidney or injection of ligustrazine in rats].

作者信息

Guo Xue-Li, Huang Xiu-Zhen, Shi De

机构信息

Department of General Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, PR China.

出版信息

Ai Zheng. 2004 May;23(5):481-6.

Abstract

BACKGROUND & OBJECTIVE: Primary retroperitioneal tumor often invades large vessels; the difficulty of operation is the management of the vessels, especially the inferior vena cava (IVC). The suprarenal ligation of the IVC was considered to be dangerous. The aim of this study was to investigate the cardiac hemodynamics following suprarenal ligation of the IVC and the resection of the right kidney or injection of ligustrazine in rats, and to provide theories and guides for the clinical operations.

METHODS

The rats were divided into six groups of seven. The groups were control group, false operation group, suprarenal ligation of the IVC group, suprarenal ligation of IVC and resection of right kidney group, ligustrazine group, and placebo group. All rats were determined for heart rate, ejection fraction, cardiac output, stroke volume, arterial pressure at 1st, 6th, 24th, 48th hour after the operations.

RESULTS

The indexes of the false operation group had no change. CO(0.018+/-0.002 L/min), SV(0.054+/-0.008 ml), AP(H)(173+/-12 mmHg), AP(L)(161+/-11 mmHg) decreased to the lowest point at 1st hour following the suprarenal ligation of the IVC, but compensated completely at 48th hour after the operation. All rats in this group survived during the study period. CO(0.012+/-0.002 L/min), SV(0.038+/-0.005 ml), AP(H)(138+/-8 mmHg), AP(L)(131+/-9 mmHg)decreased to the lowest point at 1st hour following the suprarenal ligation of the IVC and resection of the right kidney, CO and SV were not compensated completely at 48th hour after the operation, two rats died in this group. CO (0.025+/-0.004 L/min), SV(0.063+/-0.009 ml), AP(H)(190+/-14 mmHg), AP(L)(163+/-9 mmHg)decreased to the lowest point at 1st hour following the suprarenal ligation of the IVC, but compensated quickly at 24th hour after the operation, all rats survived in this group. The placebo group, compared with the ligustrazine group, had no obvious change.

CONCLUSION

Cardiac function was affected by low returned blood volume following the suprarenal ligation of the IVC, but compensated completely at 48th hour after the operation. The suprarenal ligation of the IVC and injection of ligustrazine could improve cardiac function of the experimental rats. The suprarenal ligation of the IVC and resection of the right kidney, which not only increased the operative difficulty but also reduced cardiac functional compensation and appeared the death of rats, were not appropriate. We suggest to ligate the suprarenal IVC and to inject ligustrazine after resecting the tumor and infiltrated IVC, not to resect normal right kidney. To infuse solution by upper limb to increase returned blood volume in early phase after the operation.

摘要

背景与目的

原发性腹膜后肿瘤常侵犯大血管,手术难点在于血管处理,尤其是下腔静脉(IVC)。IVC肾上腺水平结扎被认为具有危险性。本研究旨在探讨大鼠IVC肾上腺水平结扎并切除右肾或注射川芎嗪后的心脏血流动力学变化,为临床手术提供理论依据和指导。

方法

将大鼠分为6组,每组7只。分组为对照组、假手术组、IVC肾上腺水平结扎组、IVC肾上腺水平结扎并切除右肾组、川芎嗪组和安慰剂组。于术后第1、6、24、48小时测定所有大鼠的心率、射血分数、心输出量、每搏量、动脉压。

结果

假手术组各项指标无变化。IVC肾上腺水平结扎组术后第1小时,CO(0.018±0.002L/min)、SV(0.054±0.008ml)、AP(H)(173±12mmHg)、AP(L)(161±11mmHg)降至最低点,但术后48小时完全代偿。该组所有大鼠在研究期间存活。IVC肾上腺水平结扎并切除右肾组术后第1小时,CO(0.012±0.002L/min)、SV(0.038±0.005ml)、AP(H)(138±8mmHg)、AP(L)(131±9mmHg)降至最低点,术后48小时CO和SV未完全代偿,该组有2只大鼠死亡。IVC肾上腺水平结扎组术后第1小时,CO(0.025±0.004L/min)、SV(0.063±0.009ml)、AP(H)(190±14mmHg)、AP(L)(163±9mmHg)降至最低点,但术后24小时迅速代偿,该组所有大鼠存活。安慰剂组与川芎嗪组相比,无明显变化。

结论

IVC肾上腺水平结扎后因回心血量减少影响心脏功能,但术后48小时完全代偿。IVC肾上腺水平结扎及注射川芎嗪可改善实验大鼠心脏功能。IVC肾上腺水平结扎并切除右肾不仅增加手术难度,还降低心脏功能代偿能力并导致大鼠死亡,不合适。建议在切除肿瘤及受侵IVC后结扎肾上腺水平IVC并注射川芎嗪,而非切除正常右肾。术后早期经上肢补液以增加回心血量。

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