Liao X P, She Y X, Shi C R, Li M
Department of Pediatric Surgery, Xinhua Hospital, Shanghai Second Medical University, People's Republic of China.
J Pediatr Surg. 1995 Oct;30(10):1412-5. doi: 10.1016/0022-3468(95)90394-1.
New Zealand rabbits were assigned randomly to three groups: sham operation, intestinal simple obstruction, and strangulation obstruction. To relate possible changes in the body fluid content of biochemical markers to the strangulation process, subsequent samples of blood and peritoneal fluid, for the determination of levels of creatine kinase (CK), lactic acid (LA), xanthine oxidase (XO), and inorganic phosphate (IP), were obtained at 1-, 2-, 4-, and 6-hour intervals, and intestinal histological specimens were graded blindly. Significant increases in plasma LA (3.93 +/- 0.26 v 2.99 +/- 0.37; P < .05), peritoneal LA (5.03 +/- 1.14 V 3.33 +/- 0.86; P < .05), and CK (940 +/- 146 v 772 +/- 165, P < .05) occurred after 1 hour of ischemic injury. Except for serum CK, all parameters in the blood and peritoneal fluid in group 3 were markedly elevated within 4 hours. The serum CK remained almost unchanged throughout the 6-hour study period. The results suggest that plasma LA, peritoneal LA, and CK are sensitive indicators in the early diagnosis of bowel ischemia; the determination of both serum and peritoneal XO and IP was also helpful for early diagnosis; in contrast, serum CK was not a useful indicator. The value of any biochemical marker as an early diagnostic tool for intestinal ischemia depends not only on its quantity but also on its location and mechanism of release.
假手术组、单纯性肠梗阻组和绞窄性肠梗阻组。为了将生化标志物体液含量的可能变化与绞窄过程联系起来，在1、2、4和6小时间隔采集血液和腹腔液样本，以测定肌酸激酶（CK）、乳酸（LA）、黄嘌呤氧化酶（XO）和无机磷酸盐（IP）的水平，并对肠道组织学标本进行盲法分级。缺血损伤1小时后，血浆LA（3.93±0.26对2.99±0.37；P<0.05）、腹腔LA（5.03±1.14对3.33±0.86；P<0.05）和CK（940±146对772±165，P<0.05）显著升高。除血清CK外，第3组血液和腹腔液中的所有参数在4小时内均显著升高。在整个6小时的研究期间，血清CK几乎保持不变。结果表明，血浆LA、腹腔LA和CK是肠缺血早期诊断的敏感指标；血清和腹腔XO及IP的测定对早期诊断也有帮助；相比之下，血清CK不是一个有用的指标。任何生化标志物作为肠缺血早期诊断工具的价值不仅取决于其数量，还取决于其释放的位置和机制。
