Effects of Intraluminal Pressure and Decompression on Intestinal Obstruction

在小肠梗阻中，扩张肠腔内的压力是其病理生理学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学，研究了小肠梗阻的腔内压力、局部血流量和血清内毒素。本文还研究了内毒素休克时肝血流动力学的变化。每24小时测量膨胀肠的管腔内压力，持续三天，同时狗保持俯卧位而不被麻醉。在测量管腔内压力时，使用与个人计算机连接的液压毛细血管输注系统（Arndorfer：AMS-600）。人们认为，该系统测量的肠道腔内压力值更具生理性。单纯性肠梗阻后第2天腔内压明显升高。术后3天平均腔内压。空肠梗阻为17.9 mmhg，回肠为20.2 mmhg。我们实验中的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，记录的平均压力为30 mmHg。实验性单纯性小肠梗阻也出现局部血流改变和血清内毒素水平升高，我们的研究摒弃了肠腔内压力升高直接引起血管淤滞、水肿，最终导致缺血性损伤的简单概念。提示肠梗阻的病理生理过程与肠腔内压力升高、肠分泌活动、肠吸收障碍、细菌植物群大量繁殖及化学介质物质等因素有关。

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.