暂时性腹腔关闭装置对小型猪腹部开放伤并腹内高压的实验研究

摘要

目的观察新型暂时性腹腔关闭装置对小型猪腹部开放伤并腹内高压模型病理生理影响，探讨其临床应用价值。方法贵州小型香猪20只，随机分为常规手术关腹组(n=10)和新装置组(n=10)。制作腹部开放伤合并腹内高压动物模型，在不同时间点检测两组血流动力学、腹内压、腹腔灌注压及动脉血气等指标变化。结果常规关腹组(O组)伤后6 h心率即明显增快(P＜0.01)，平均动脉压(mean arterial blood pressure，MAP)及心输出量(cardiac output，CO)于伤后48 h开始明显下降(P＜0.01)；腹内压(intra-abdominal pressure，IAP)随时间而持续升高，同时腹腔灌注压(abdominal perfusion pressure，APP)呈进行性下降。新装置组(N组)从伤后12 h始上述指标与O组差异有统计学意义(P＜0.05)。O组关腹后随时间推移逐渐出现显著的CO2蓄积和严重的低氧血症；N组自24 h起PCO2、PO2、SO2与O组相比均有统计学差异(P＜0.05)。O组死亡率40%，N组在观测时间内没有动物死亡，且操作时间明显少于常规关腹组(P＜0.01)。结论新型暂时性腹腔关闭装置操作便捷，便于急救状态下应用，在腹部开放伤并腹内高压动物模型中能有效预防腹内压升高，改善腹腔灌注压、血流动力学及动脉血气等指标，降低死亡率，具有良好的临床应用前景。%Objective To study the value of temporary abdominal closure device in clinical practice by observing its patho-physiological effect in miniature pigs with open abdominal wounds and intra-abdominal hypertension. Methods Twenty Guizhou miniature pigs were randomly divided into conventional abdominal closure group and novel device group (10 in each group). A pig abdominal open wound and intra-abdominal hypertension model was established. Hemodynamics, intra-abdominal pressure (IAP), abdominal perfusion pressure (APP) and arterial blood gas in the two groups were measured at different time points. Results The heart rate was significantly higher 6 h after open abdominal wounds while the mean arterial blood pressure (MAP) and cardiac output (CO) were significantly lower 48 h after open abdominal wounds in conventional abdominal closure group than in novel device group (P<0.01). The IAP increased while the APP decreased with the prolongation of time. A significant difference was observed in the heart rate, MAP and CO, IAP and APP between the two groups 12 h open abdominal wounds (P < 0.05). Significant CO2 accumulation and severe hypoxemia occurred after abdominal closure. A significant difference was found in the PCO2, PO2 and SO2 between the two groups (P<0.05). The mortality of conventional abdominal closure group was 40%. However, no death occurred in novel device group. The operation time was significantly shorter in novel device group than in conventional abdominal closure group (P < 0.01). Conclusion The novel temporary abdominal closure device can reduce the mortality of patients by effectively preventing intra-abdominal hypertension and improving abdominal perfusion pressure, hemodynamic index and arterial blood gas due to its easy application in emergency situation, thus having a bright prospect of clinical application.