Effects of Intraluminal Pressure and Decompression on Intestinal Obstruction

在小肠梗阻中，膨胀肠的腔内压力是其病理生理中最重要和最基本的因素之一。为了阐明肠梗阻的部分病理生理，我们对小肠梗阻的腔内压、局部血流和血清内毒素进行了研究。研究了内毒素休克时肝血流动力学。实验研究了犬小肠非绞窄性梗阻。在不麻醉的情况下，犬保持俯卧位，每24小时测量一次膨胀肠腔内压，连续3天。在测量腔内压力时，使用与个人计算机连接的液压毛细管输注系统（Arndorfer: AMS-600）。据认为，由该系统测量的肠腔内压力值更具有生理性。单纯性肠梗阻后2天出现明显的腔内压升高。术后3天平均腔内压。空肠梗阻17.9 MMHG，回肠20.2 MMHG。在我们的实验中，腔内压力值比过去报道的要高。在前列腺素引起的运动反应中，平均血压为30 mmHg。在实验性单纯性小肠梗阻中，局部血流的改变和血清内毒素水平的升高也表现出来。我们的研究放弃了增加腔内压力直接引起血管停滞、水肿和最终缺血性损伤的简单概念。提示肠腔内压力升高、肠道分泌活性、肠道吸收障碍、菌群大量繁殖、化学介质物质等因素与肠梗阻的病理生理有关。

In small bowel obstruction, intraluminal pressure in the distended bowel is one of the most important and basic factors in its pathophysiology. To elucidate a part of the pathophysiology of the bowel obstruction, intraluminal pressure, regional blood flow, and serum endotoxin in small bowel obstruction were investigated. Hemodynamics of hepatic blood flow in endotoxin shock was also studied.Nonstrangulative obstruction was induced experimentally in the canine small intestine of dogs. The intraluminal pressure of the distended intestine was measured every 24 hours for three days, while the dogs were kept in a prone position without being anesthetized. In the measurement of the intraluminal pressure, the hydraulic capillary infusion system (Arndorfer : AMS-600) connected with personal computer was used. It is considered that the intraluminal pressure values of the intestine, as measured by this system, are more physiologic. The significant elevation of the intraluminal pressure was showed on 2 days after simple bowel obstruction. The mean intraluminal pressure on 3 days after. obstruction was 17.9 mmhg in jejunum, and 20.2 mmhg in ileum. The intraluminal pressure values in our experiments are higher than those reported in the past. In motility responses elicited by prostaglandin, the mean pressure amounting 30 mmHg were recorded. Some alterations in regional blood flow and elevation of serum endotoxin levels were also showed in the experimental simple small bowel obstruction.The simple concept of increasing intraluminal pressure provoking directly vascular stasis, edema, and eventually, ischemic damage was abandoned by our studies. It, is suggested that many factors such as elevation of intraluminal pressure, secretory activity of intestine, absorptional disorder of intestine, a tremendous broliferation of the bacterial flora, and chemical mediator sustances are related to the pathophysiology of the intestinal obstruction.