Lima Ricardo, Silva Pedro L, Capelozzi Vera L, Oliveira Mariana G, Santana Maria Cristina E, Cruz Fernanda F, Pelosi Paolo, Schanaider Alberto, Malbrain Manu L N G, Rocco Patricia R M
Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
Anaesthesiol Intensive Ther. 2017;49(2):130-138. doi: 10.5603/AIT.a2017.0021. Epub 2017 May 14.
Abdominal compartment syndrome (ACS) sometimes occurs in critically ill patients following damage control surgery. The purpose of the present study was to develop a model of ACS and to evaluate its pathologic impact on liver, kidney, and lung morphology.
Twenty Wistar rats (mass 300-350 g) were randomly divided into four groups: 1) intra-abdominal hypertension (IAH): a laparotomy was performed and the abdomen packed with cotton until an intra-abdominal pressure (IAP) of 15 mm Hg was reached; 2) hypovolemia (HYPO): blood was withdrawn until a mean arterial pressure ~60 mm Hg was reached; 3) IAH + HYPO (to resemble clinical ACS); and 4) sham surgery. After 3 hours of protective mechanical ventilation, the animals were euthanized and the liver, kidney and lungs removed to examine the degree of tissue damage.
IAH resulted in the following: oedema and neutrophil infiltration in the kidney; necrosis, congestion, and microsteatosis in the liver; and alveolar collapse, haemorrhage, interstitial oedema, and neutrophil infiltration in the lungs. Furthermore, IAH was associated with greater cell apoptosis in the kidney, liver and lungs compared to sham surgery. HYPO led to oedema and neutrophil infiltration in the kidney. The combination of IAH and HYPO resulted in all the aforementioned changes in lung, kidney and liver tissue, as well as exacerbation of the inflammatory process in the kidney and liver and kidney cell necrosis and apoptosis.
Intra-abdominal hypertension by itself is associated with kidney, liver and lung damage; when combined with hypovolemia, it leads to further impairment and organ damage.
腹腔间隔室综合征（ACS）有时会在危重症患者接受损伤控制手术后出现。本研究的目的是建立ACS模型，并评估其对肝脏、肾脏和肺形态的病理影响。
将20只体重300 - 350克的Wistar大鼠随机分为四组：1）腹腔内高压（IAH）组：进行剖腹手术，用棉花填充腹腔直至腹腔内压力（IAP）达到15毫米汞柱；2）低血容量（HYPO）组：抽血直至平均动脉压达到约60毫米汞柱；3）IAH + HYPO组（模拟临床ACS）；4）假手术组。在进行3小时的保护性机械通气后，对动物实施安乐死，取出肝脏、肾脏和肺以检查组织损伤程度。
IAH导致以下情况：肾脏出现水肿和中性粒细胞浸润；肝脏出现坏死、充血和微脂肪变性；肺出现肺泡萎陷、出血、间质水肿和中性粒细胞浸润。此外，与假手术相比，IAH导致肾脏、肝脏和肺中的细胞凋亡增加。HYPO导致肾脏出现水肿和中性粒细胞浸润。IAH与HYPO的联合作用导致肺、肾脏和肝脏组织出现上述所有变化，以及肾脏和肝脏炎症过程加剧、肾细胞坏死和凋亡。
单纯腹腔内高压与肾脏、肝脏和肺损伤相关；与低血容量合并时，会导致进一步的功能损害和器官损伤。
