Ni Hai-bin, Li Wei-qin, Ke Lu, Tong Zhi-hui, Nie Yao, Sun Jia-kun, Li Ning, Li Jie-shou
Research Institute of General Surgery, School of Medicine, Nanjing University, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
Zhonghua Wai Ke Za Zhi. 2011 May 1;49(5):428-31.
To assess the effect of intra-abdominal hypertension (IAH) on hemodynamics of severe acute pancreatitis (SAP) in porcine model.
Following baseline registrations, SAP was induced in 12 animals. The N(2) pneumoperitoneum was used to increase the intra-abdominal pressure to 30 mmHg (1 mmHg = 0.133 kPa) in 6 of 12 SAP animals thereafter and keep constant during the experiment. The investigation period was 12 h. Heart rate, cardiac output (CO), central venous pressure (CVP), mean arterial pressure and pulmonary arterial wedge pressure (PAWP) were continuously measured with the aid of balloon tipped flow-directed catheter and electrocardiography monitor. Oxygen partial pressure of artery (PaO(2)), carbon dioxide partial pressure of artery (PaCO(2)), ScvO(2), base excess (BE), and blood lactic acid (LAC) were measured by acid-base analysis.
In the IAH group, CO decreased significantly at 12 h, CVP and PAWP increased significantly at 3 h, 6 h and 12 h compared with SAP group (all P < 0.05). Peak inspiration pressure increased immediately after pneumoperitoneum in the IAH group, to (50.2 ± 3.1) cmH(2)O (1 cmH(2)O = 0.098 kPa) and (49.8 ± 0.9) cmH(2)O at 6 h and 12 h respectively. The pH, PaO(2), ScvO(2) and BE showed a tendency to fall in the IAH group. PaCO(2) and LAC were increased significantly in the IAH group (all P < 0.05).
There were remarkable and relatively irreversible effects on global hemodynamics in response to sustained IAH of 12 h with the underlying condition of SAP. Abdominal decompression is beneficial for patients of SAP with IAH.
在猪模型中评估腹腔内高压（IAH）对重症急性胰腺炎（SAP）血流动力学的影响。
在进行基线记录后，对12只动物诱导产生SAP。此后，在12只SAP动物中的6只中使用N₂气腹将腹腔内压力升高至30 mmHg（1 mmHg = 0.133 kPa），并在实验过程中保持恒定。研究期为12小时。借助带气囊的血流导向导管和心电图监测仪连续测量心率、心输出量（CO）、中心静脉压（CVP）、平均动脉压和肺动脉楔压（PAWP）。通过酸碱分析测量动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、ScvO₂、碱剩余（BE）和血乳酸（LAC）。
与SAP组相比，IAH组在12小时时CO显著降低，CVP和PAWP在3小时、6小时和12小时时显著升高（均P < 0.05）。IAH组气腹后吸气峰压立即升高，在6小时和12小时时分别升至（50.2 ± 3.1）cmH₂O（1 cmH₂O = 0.098 kPa）和（49.8 ± 0.9）cmH₂O。IAH组的pH、PaO₂、ScvO₂和BE呈下降趋势。IAH组的PaCO₂和LAC显著升高（均P < 0.05）。
在SAP基础状况下，持续12小时的IAH对整体血流动力学有显著且相对不可逆的影响。腹腔减压对合并IAH的SAP患者有益。
