Novikova O V, Yavorovsky A G, Komarov R N, Zhidkov I L, Popov A M, Pojufina N V
Anesteziol Reanimatol. 2016 Sep;61(5):344-348.
To identify the role of the intestine in the development of metabolic disorders with operations in the thoracoabdominal aorta developing after clamping of the aorta above the celiac trunk Materials and methods. The study was conducted in pigs (n = 6) with similar body weight (m = 35-39 kg). After the intoduction of animal anesthesia, surgery was performed by access to the visceral veins (upper and lower mesenteric kidney, liver spleen andfemur), from which the Blood samples to determine the concentration of lactate, glucose, as well as indicators of acid-base status. Then placing the clamp on the aorta above the level of discharge of the celiac trunk. Blood sampling and laboratory diagnosis carried out twice: before clamping the aorta and blood flow before the start after 60 minutes of ischemia. Histological study intestinal tissue also conducted.
It is shown that the aorta cross-clamping develops pronounced metabolic disorders, manifested in the form of increased levels of lactate and glucose concentrations in all investigated parts of the splanchnic region. The most pronounced increase in lactate after clamping the aorta was observed in the blood samples flowing from the intestine. The results of histological studies show that intestinal hypoperfusion leads to severe pathological changes, that is a predisposing factor leading to the translocation of bacterial agents into the systemic circulation, to the process of expression of systemic inflammatory response and a powerful oxidative stress.
Our experimental data show that when aortic clamping above the celiac trunk (ischemia mesenteric region) the greatest quantitative contribution to metabolic disorders the body of the animal created in a pathophysiological situation contributes to intestinal hypoperfusion. In this regard, one of the main tactics of the anaesthetist in the perioperative period should be the protection of the intestine against ischemia and its consequences.
通过在腹腔干上方夹闭主动脉后进行胸主动脉手术,确定肠道在代谢紊乱发展中的作用。材料与方法。该研究在体重相似(35 - 39千克)的猪(n = 6)身上进行。在动物麻醉后,通过进入内脏静脉(肠系膜上、下静脉、肾静脉、肝静脉、脾静脉和股静脉)进行手术,从中采集血样以测定乳酸、葡萄糖浓度以及酸碱状态指标。然后在腹腔干发出水平上方夹闭主动脉。在夹闭主动脉前和缺血60分钟后开始血流前进行两次血样采集和实验室诊断。还对肠道组织进行了组织学研究。
结果表明,主动脉交叉夹闭会引发明显的代谢紊乱,表现为内脏区域所有被研究部位的乳酸水平和葡萄糖浓度升高。在从肠道流出的血样中观察到夹闭主动脉后乳酸增加最为明显。组织学研究结果表明,肠道灌注不足会导致严重的病理变化,这是导致细菌因子易位进入体循环、引发全身炎症反应和强烈氧化应激过程的一个诱发因素。
我们的实验数据表明,当在腹腔干上方夹闭主动脉(肠系膜区域缺血)时,动物体内对代谢紊乱的最大定量贡献是由病理生理状况下的肠道灌注不足造成的。在这方面,麻醉师在围手术期的主要策略之一应该是保护肠道免受缺血及其后果的影响。