The effect of intra-abdominal hypertension incorporating severe acute pancreatitis in a porcine model.
The effect of intra-abdominal hypertension incorporating severe acute pancreatitis in a porcine model.
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DOI：
10.1371/journal.pone.0033125
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Li JS
中科院分区：
文献类型：
--
作者：
Ke L;Tong ZH;Ni HB;Ding WW;Sun JK;Li WQ;Li N;Li JS
腹腔室隔综合征(ACS)和腹内高压(IAH)是重症急性胰腺炎(SAP)患者常见的临床表现。目前认为腹内压(IAP)升高与SAP患者预后不良有关。但IAH/ACS对不同器官系统的具体作用尚不清楚。本研究的目的是评估SAP联合IAH对持续12小时的猪模型的血流动力学、全身氧合和器官损伤的影响。30只动物随机分为5组(每组6只)：SAP+IAP30组、SAP+IAP20组、SAP组、IAP30组(假手术但无SAP)和假手术组。我们用氮气气腹诱导不同水平的IAH，并逆行胆管内注射牛磺胆酸钠诱导SAP。观察时间为12h，记录血流动力学参数(CO、HR、MAP、CVP)、尿量、氧合参数(SvO2、PO2、PaCO2)、最大吸气压以及血清参数(ALT、淀粉酶、乳酸、肌酐)。取肝、肠、胰腺、肺进行组织学检查。SAP+IAH组动物的心输出量明显低于其他组。此外，AST、肌酐、SUN、乳酸的升高趋势与SvO2显著降低的趋势相似。组织病理学检查显示SAP+IAH组大鼠肝、肠、胰腺和肺组织损伤程度较重。然而，不同IAP水平的SAP+IAH组之间差异不大。我们新建立的猪SAP+IAH模型表明，持续12h的IAH联合SAP对整体血流动力学、氧合和器官功能均有显著影响。此外，我们的模型将有助于研究IAH/ACS诱导的恶化的机制，并优化治疗策略以对抗器官功能障碍的发展。
Abdominal compartment syndrome (ACS) and intra abdominal hypertension(IAH) are common clinical findings in patients with severe acute pancreatitis(SAP). It is thought that an increased intra abdominal pressure(IAP) is associated with poor prognosis in SAP patients. But the detailed effect of IAH/ACS on different organ system is not clear. The aim of this study was to assess the effect of SAP combined with IAH on hemodynamics, systemic oxygenation, and organ damage in a 12 h lasting porcine model. Following baseline registrations, a total of 30 animals were divided into 5 groups (6 animals in each group): SAP+IAP30 group, SAP+IAP20 group, SAP group, IAP30 group(sham-operated but without SAP) and sham-operated group. We used a N2 pneumoperitoneum to induce different levels of IAH and retrograde intra-ductal infusion of sodium taurocholate to induce SAP. The investigation period was 12 h. Hemodynamic parameters (CO, HR, MAP, CVP), urine output, oxygenation parameters(e.g., SvO2, PO2, PaCO2), peak inspiratory pressure, as well as serum parameters (e.g., ALT, amylase, lactate, creatinine) were recorded. Histological examination of liver, intestine, pancreas, and lung was performed. Cardiac output significantly decreased in the SAP+IAH animals compared with other groups. Furthermore, AST, creatinine, SUN and lactate showed similar increasing tendency paralleled with profoundly decrease in SvO2. The histopathological analyses also revealed higher grade injury of liver, intestine, pancreas and lung in the SAP+IAH groups. However, few differences were found between the two SAP+IAH groups with different levels of IAP. Our newly developed porcine SAP+IAH model demonstrated that there were remarkable effects on global hemodynamics, oxygenation and organ function in response to sustained IAH of 12 h combined with SAP. Moreover, our model should be helpful to study the mechanisms of IAH/ACS-induced exacerbation and to optimize the treatment strategies for counteracting the development of organ dysfunction.
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影响因子：
120.7
作者：
Jones, Alan E.;Shapiro, Nathan I.;Trzeciak, Stephen;Arnold, Ryan C.;Claremont, Heather A.;Kline, Jeffrey A.
通讯作者：
Kline, Jeffrey A.
影响因子：
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影响因子：
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通讯作者：
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作者：
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通讯作者：
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作者：
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通讯作者：
Ammori, Basil J.