Department of General Surgery, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, China.
PLoS One. 2012;7(3):e33125. doi: 10.1371/journal.pone.0033125. Epub 2012 Mar 5.
Abdominal compartment syndrome (ACS) and intra abdominal hypertension(IAH) are common clinical findings in patients with severe acute pancreatitis(SAP). It is thought that an increased intra abdominal pressure(IAP) is associated with poor prognosis in SAP patients. But the detailed effect of IAH/ACS on different organ system is not clear. The aim of this study was to assess the effect of SAP combined with IAH on hemodynamics, systemic oxygenation, and organ damage in a 12 h lasting porcine model.
Following baseline registrations, a total of 30 animals were divided into 5 groups (6 animals in each group): SAP+IAP30 group, SAP+IAP20 group, SAP group, IAP30 group(sham-operated but without SAP) and sham-operated group. We used a N(2) pneumoperitoneum to induce different levels of IAH and retrograde intra-ductal infusion of sodium taurocholate to induce SAP. The investigation period was 12 h. Hemodynamic parameters (CO, HR, MAP, CVP), urine output, oxygenation parameters(e.g., S(v)O(2), PO(2), PaCO(2)), peak inspiratory pressure, as well as serum parameters (e.g., ALT, amylase, lactate, creatinine) were recorded. Histological examination of liver, intestine, pancreas, and lung was performed.
Cardiac output significantly decreased in the SAP+IAH animals compared with other groups. Furthermore, AST, creatinine, SUN and lactate showed similar increasing tendency paralleled with profoundly decrease in S(v)O(2). The histopathological analyses also revealed higher grade injury of liver, intestine, pancreas and lung in the SAP+IAH groups. However, few differences were found between the two SAP+IAH groups with different levels of IAP.
Our newly developed porcine SAP+IAH model demonstrated that there were remarkable effects on global hemodynamics, oxygenation and organ function in response to sustained IAH of 12 h combined with SAP. Moreover, our model should be helpful to study the mechanisms of IAH/ACS-induced exacerbation and to optimize the treatment strategies for counteracting the development of organ dysfunction.
腹腔间隔室综合征（ACS）和腹腔内高压（IAH）是重症急性胰腺炎（SAP）患者常见的临床发现。人们认为，腹内压（IAP）升高与 SAP 患者的预后不良有关。但 IAH/ACS 对不同器官系统的详细影响尚不清楚。本研究旨在评估 SAP 合并 IAH 对持续 12 小时猪模型中血流动力学、全身氧合和器官损伤的影响。
在基线记录后，共 30 只动物分为 5 组（每组 6 只）：SAP+IAP30 组、SAP+IAP20 组、SAP 组、IAP30 组（假手术但无 SAP）和假手术组。我们使用 N(2)气腹诱导不同程度的 IAH，并逆行胰管内输注牛磺胆酸钠诱导 SAP。研究期为 12 小时。记录血流动力学参数（CO、HR、MAP、CVP）、尿量、氧合参数（如 S(v)O(2)、PO(2)、PaCO(2))、吸气峰压以及血清参数（如 ALT、淀粉酶、乳酸、肌酐）。对肝、肠、胰腺和肺进行组织学检查。
与其他组相比，SAP+IAH 动物的心输出量显著下降。此外，AST、肌酐、SUN 和乳酸也表现出相似的升高趋势，同时 S(v)O(2)显著降低。组织病理学分析还显示 SAP+IAH 组肝、肠、胰腺和肺的损伤程度更高。然而，在具有不同 IAP 水平的两个 SAP+IAH 组之间，差异并不明显。
我们新开发的 SAP+IAH 猪模型表明，持续 12 小时 IAH 合并 SAP 对全身血流动力学、氧合和器官功能有明显影响。此外，我们的模型有助于研究 IAH/ACS 诱导恶化的机制，并优化对抗器官功能障碍发展的治疗策略。
