摘要
目的评价控制性低CVP对兔肝缺血再灌注损伤的影响。方法新西兰大白兔32只，随机分为4组（n=8）：假手术组（S组）、控制性低CVP组（L组）、肝缺血再灌注组（IR组）和控制性低CVP下肝缺血再灌注组（LIR组）。L组静脉输注硝酸甘油10～30μg·kg^-1·min^-1和多巴胺30～40μg·kg^-1·min^-1，在5min内使CVP降至4—5cmH2O且维持MAP≥90mmHg，持续至再灌注6h。IR组采用夹闭肝门30min后再开放的方法建立肝缺血再灌注模型。LIR组在控制性低CVP模型制备成功后立即进行肝缺血再灌注。分别于实施控制性低CVP前（T0，基础状态）、再灌注即刻（T1）、30min（T2）、1h（T3）、2h（T4）、4h（T5）、6h（T6）时采用彩色超声多普勒诊断仪测定门静脉、肝动脉和肝静脉的血流速度，同时采集动脉血样，测定血浆AST和ALT的活性。于再灌注6h时，取肝组织，电镜下观察细胞超微结构。结果与S组比较，L组各时点门静脉、肝动脉、肝静脉的血流速度、血浆AST和ALT的活性差异无统计学意义（P〉0．05），IR组T1-5，时肝动脉血流速度减慢，T5-6时肝静脉血流速度增快，血浆AST和ALT的活性升高，LIR组T1-6时肝静脉血流速度度增快，T1～6时血浆AST和ALT的活性升高（P〈0．05）；与IR组比较，LIR组T1-2时肝动脉血流速度增快，T1-6时肝静脉血流速度增快，T1,4-6时血浆ALT和AST的活性降低（P〈0．05）。与IR组比较，LIR组肝细胞线粒体及窦周间隙面微绒毛的肿胀程度减轻，肝血窦窦壁覆盖完整。结论控制性低CVP可减轻兔肝缺血再灌注损伤，其机制可能与增加再灌注期间肝血流量，减轻肝细胞及肝血窦损伤，从而改善肝灌注有关。
Objective To investigate the effect of controlled low CVP （CL-CVP） on blood flow, liver enzyme and ultrastructure of liver after hepatic ischemia-reperfusion （I/R） injury in rabbits. Methods Thirty-two healthy New Zealand white rabbits of both sexes weighing 1.9-2.2 kg were randomly divided into 4 groups （ n = 8 each）： groupⅠ control （group C）; groupⅡ CL-CVP; groupⅢ I/R and group ⅣCL-CVP＋ I/R. The animals were anesthetized with iv 3 % pentobarbital 30 mg/kg, tracheostomized and mechanically ventilated. In group Ⅱ and Ⅳ CVP was reduced to and maintained at 4-5 cm H2O by intraglycerin infusion at 10-30μg·kg^-1·min^-1 while MAP was maintained ≥ 90 mm Hg by dopamine infusion at 30-40 μg·kg^-1·min^-1. In group m and IV hepatic ischemia was produced by occluding portal vein and hepatic artery for 30 min followed by reperfusion. Blood flow velocity of hepatic artery and vein and blood ALT and AST activities were measured before induction of low CVP, at 0, 30 min, 1,2,4 and 6 h of reperfusion. Results （1） Low CVP did not affect blood flow velocity of hepatic artery and vein. Blood flow velocity of hepatic artery was reduced while that of hepatic vein was increased by I/R. Blood flow velocity of hepatic artery and vein was significantly increased in group Ⅳ （group CL-CVP ＋ I/R） as compared with group m 〈group I/R）. （2） Blood ALT and AST activities were not affected by low CVP but significant increased by hepatic I/R. Low CVP significantly attenuated I/R-induced increase in AST and ALT activities. （3） Low CVP significantly ameliorated liver damage induced by I/R. Conclusion Controlled low CVP can attenuate hepatic I/R injury in rabbits.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2010年第2期205-208,共4页
Chinese Journal of Anesthesiology
基金
重庆市卫生局项目（2009-2-323）
关键词
降压
控制性
再灌注损伤
肝
Hypotension, controlled
Reperfusion injury
Liver
