[在腹腔干以上主动脉夹紧期间肠缺血在代谢紊乱中的作用]

O. Novikova, A. Yavorovsky, R. Komarov, I. L. Zhidkov, A. Popov, N. V. Pojufina
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摘要

目的探讨胸腹主动脉夹持后腹腔主干上的代谢性疾病的发生过程中肠的作用。研究对象为体重相近(m = 35-39 kg)的猪(n = 6)。引入动物麻醉后,手术通过进入内脏静脉(上、下肠系膜肾、肝、脾、股骨),从中取血标本,测定乳酸、葡萄糖浓度,以及酸碱状态指标。然后将钳夹在主动脉上置于乳糜干排出的上方。进行两次采血和实验室诊断:夹紧主动脉前和缺血60分钟后开始血流前。对肠组织也进行了组织学研究。结果主动脉交叉夹紧会产生明显的代谢紊乱,表现为内脏所有被调查部位的乳酸和葡萄糖浓度水平升高。在从肠流出的血液样本中观察到夹住主动脉后乳酸浓度的显著增加。组织学研究结果表明,肠道低灌注导致严重的病理改变,是导致细菌因子易位进入体循环的易感因素,导致全身性炎症反应的表达过程和强大的氧化应激。结论主动脉夹夹在腹腔干以上(缺血肠系膜区)是动物机体在病理生理状态下产生的代谢紊乱的最大定量贡献,导致肠道灌流不足。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。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[THE ROLE OF INTESTINE ISCHEMIA IN METABOLIC DISORDERS DURING THE AORTIC CLAMPING ABOVE THE CELIAC TRUNK.]
THE AIM 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. RESULTS 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. CONCLUSION 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.
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