控制性低中心静脉压对兔肝缺血再灌注损伤保护作用的研究剖析.docVIP

控制性低中心静脉压对兔肝缺血再灌注损伤保护作用的研究 重庆医科大学附属第一医院麻醉科 400016 邓圻玮希 闵苏 何开华 程波 【摘要】 目的 研究控制性低中心静脉压（CLCVP）（IRI）32只，随机分为4组C组）、单纯CLCVP组（L组）、肝IRI组（IR组）、CLCVP下肝IRI组（LIR组）。麻醉后，L组建立CLCVP模型（CVP 4-5 cmH2O, MAP≥90 mmHg）IR组建立肝IRI模型(夹闭肝门1/2 h后开放)，LIR组建立CLCVP模型和肝IRI模型。分别于各组处理前(T0)、CLCVP模型建立(肝IRI血流开放)即刻(T1)、1/2 h(T2)、1 h(T3)、2 h(T4)、4 h(T5)、6 h(T6)ALT、AST1、与C组比， L组各时点间肝脏动静脉流速差异无统计学意义，IR组T1-5时点肝动脉流速减慢(P0.05)，IR组T5、6时点及LIR组T1-6时点肝静脉流速增快(P0.05)；与IR组比，LIR组T1、2时点肝动脉流速增快(P0.05)，LIR组T1-6时点肝静脉流速增快(P0.05)。2、L组各时点AST和ALT较组差异无统计学意义。IR 组和LIR组T1-6时点AST、ALT较C组和L组增高(P0.05)；IR组T、时点ALT和AST值均高于LIR组(P0.05)。3、C组和L组超微结构未见异常。LIR组较IR组肝细胞线粒体肿胀减轻，血窦面微绒毛稍有肿胀，肝血窦覆盖完整。结论 CLCVP对肝IRI有一定保护作用，其机制可能与改善肝IRI后肝血流情况，减轻肝细胞及肝血窦损伤，改善器官灌注有关。 【关键词】控制性中心静脉压；缺血再灌注；肝；血流速度 controlled low central venous pressure to hepatic ischemia reperfusion injury in rabbits DENG Qi-wei-xi, MIN Su, HE Kai-hua, et al. Department of Anesthesiology, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China Corresponding author: MIN Su (E-mail: mins) [Abstract] Objective To investigate the effect of controlled low central venous pressure (CLCVP) on blood flow velocity，biochemical indicators and ultramicrostructure of rabbit liver after hepatic ischemia reperfusion injury (IRI) . Methods Thirty-two healthy New Zealand white rabbits of both sexes were randomly divided into 4 groups(n=8 each): groupⅠcontrol (C), group Ⅱ CLCVP with no IRI(L); group Ⅲ IRI (IR); group Ⅳ CLCVP+IRI (LIR). The animals were anesthetized with 3% pentobarbital 30 mg/kg through ear marginal vein, intubated and mechanically ventilated. In group L and LIR nitroglycerin 10-30 μg·kg-1·min-1 and dopamine 40-50 μg·kg-1·min-1 were pumping via femoral vein to establish the CLCVP rabbits model (CVP 4-5cmH2O, MAP ≥ 90mmHg).In group IR and LIR hepatic IRI model was produced by occluding porter vein and hepatic artery for 30 minutes followed by reperfusion. The contents of serum ALT, AST and blood flow velocity of hepatic artery and vein were measured af