肝脏撞击伤后气腹压力对肝动脉血流量的影响.DOCVIP

临床医学论文-肝脏撞击伤后气腹压力对肝动脉血流量的影响 ????????? 作者：赵松 麻晓林 张连阳 李勇? 【摘要】? 目的 研究肝撞击伤后气腹压力对肝动脉血流量的影响。方法 通过建立肝撞击伤模型，按失血量以及气腹压力的不同，随机分为9组。采用彩色微球法检测气腹前、气腹30 min、2 h以及撤去气腹后30 min肝动脉血流量的变化。结果 10、15 mm Hg气腹下30 min，12 ml/kg失血组肝动脉血流量明显少于6 ml/kg失血组(P0.05)。6 ml/kg失血组，15 mm Hg气腹下30 min，肝动脉血流量明显少于10 mm Hg气腹组(P0.05)；12 ml/kg失血组，15 mm Hg气腹下30 min，肝动脉血流量明显少于其余两种气腹压力组(P0.05)。结论 肝撞击伤伴失血后肝动脉血流量的变化与失血量、气腹压力以及气腹持续时间等有密切联系。 【关键词】? 肝脏损伤； 腹腔镜； 气腹； 肝动脉血流量 ?　　Effects of pneumoperitoneum on the hepatic arterial flow in controlled rabbit models with liver injury? ??? 【Abstract】? Objective? To investigate the hepatic arterial flow (HAF) under different intraabdominal pressures in controlled hemorrhage rabbit models with liver injury. Methods? Seventyfive New Zealand rabbits were divided into 9 groups according to the volume of blood loss and the intraabdominal pressure. Color microspheres were used to measure the HAF before pneumoperitoneum, 30 minutes under pneumoperitoneum, 2 hours under pneumoperitoneum and 30 minutes after pneumoperitoneum. Results? Under the intraabdominal pressure of 10 and 15 mm Hg for 30 minutes, the HAF of the group which had a blood loss of 12 ml/kg was significantly smaller than that of the 6 ml/kg group (P0.05). After losing blood of 6 ml/kg, the HAF of the group under the intraabdominal pressure of 15 mm Hg for 30 minutes was significantly smaller than that of the 10 mm Hg group (P0.05). After losing blood of 12 ml /kg, the HAF of the 15 mm Hg group for 30 minutes was significantly smaller than that of the 5 mm Hg group and 10 mm Hg group (P0.05). Conclusions? The changes of the HAF after liver injury may be related to the volume of blood loss, the intraabdominal pressure and the pneumoperitoneum duration. ??? 【Key words】? Liver injury;? Laparoscope;? Pneumoperitoneum;?? Hepatic arterial flow ??? 闭合性肝脏撞击伤可应用腹腔镜进行诊治，CO2气腹下影响肝动脉血流量的相关报道较少见。本研究通过建立肝撞击伤伴失血模型，研究在不同气腹压力状态下影响肝动脉血流量的因素，以期提高腹腔镜在临床应用中的安全性。 　　1? 材料与方法 　　1.1? 实验动物分组及模型制作 ??? 健康新西兰兔75只，雌雄不限，体质量(2.42±0.41)kg，由第三军医大学