Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
Eur J Vasc Endovasc Surg. 2014 Apr;47(4):402-10. doi: 10.1016/j.ejvs.2014.01.007. Epub 2014 Feb 14.
The aim of this study was to investigate the abdominal metabolic response and circulatory changes after decompression of intra-abdominal hypertension in a porcine model.
This was an experimental study with controls. Three-month-old domestic pigs of both sexes were anesthetized and ventilated. Nine animals had a pneumoperitoneum-induced IAH of 30 mmHg for 6 hours. Twelve animals had the same IAH for 4 hours followed by decompression, and were monitored for another 2 hours. Hemodynamics, including laser Doppler-measured mucosal blood flow, urine output, and arterial blood samples were analyzed every hour along with glucose, glycerol, lactate and pyruvate concentrations, and lactate-pyruvate (l/p) ratio, measured by microdialysis.
Laser Doppler-measured mucosal blood flow and urine output decreased with the induction of IAH and showed a statistically significant resolution after decompression. Both groups developed distinct metabolic changes intraperitoneally on induction of IAH, including an increased l/p ratio, as signs of organ hypoperfusion. In the decompression group the intraperitoneal l/p ratio normalized during the second decompression hour, indicating partially restored perfusion.
Decompression after 4 hours of IAH results in an improved intestinal blood flow and a normalized intraperitoneal l/p ratio.
本研究旨在探讨猪模型中腹腔内高压减压后腹部代谢反应和循环变化。
这是一项对照实验研究。3 月龄公母猪被麻醉并通气。9 只动物的气腹导致 IAH 为 30mmHg，持续 6 小时。12 只动物的 IAH 持续 4 小时后减压，并监测另外 2 小时。每小时分析血流动力学，包括激光多普勒测量的黏膜血流、尿量和动脉血样，同时通过微透析测量葡萄糖、甘油、乳酸和丙酮酸浓度以及乳酸-丙酮酸（l/p）比值。
激光多普勒测量的黏膜血流和尿量随着 IAH 的诱导而减少，并在减压后出现统计学上显著的缓解。两组在 IAH 诱导时均出现明显的腹腔内代谢变化，包括 l/p 比值升高，表明器官灌注不足。在减压组中，腹腔内 l/p 比值在减压后第 2 小时恢复正常，表明部分灌注恢复。
IAH 持续 4 小时后减压可改善肠道血流并使腹腔内 l/p 比值正常化。
