腹腔间隙综合征小肠黏膜显微和超微结构改变的观察

目的 腹腔间隙综合征(abdominal compartment syndrome,ACS)对肠黏膜屏障功能的直接损害有2种可能:肠黏膜缺血和肠黏膜细胞间紧密连接的破坏.文中通过观察20mmHg(1mmHg=0.133kPa)腹腔高压(intra-abdominal hypertension,IAH)状态下小肠绒毛光镜下结构以及细胞间紧密连接(tight junction,TJ)超微结构(电镜)的变化,找到IAH与肠黏膜和TJ变化间的关系,从而为IAH导致细菌易位找到证据.方法 SD(Sprague-Daley)大鼠40只,体重(250±25)g,随机等分为(n＝10)对照组和3个实验组,3实验组在其余条件相同的情况下,分别维持20mmHg IAH 1、2、4h.切取小肠标本,HE染色,病理组织学观察并行扫描电镜超微结构分析.结果 病理研究显示,小肠绒毛上皮细胞呈现不同程度的水肿、变性.小肠绒毛广泛剥脱、萎陷.电镜超微结构分析显示IAH下肠壁绒毛细胞间TJ肿胀.这些改变与IAH持续时间相关.结论 腹腔压力升高能造成小肠上皮细胞的显著损害和细胞间TJ的显著肿胀,导致肠黏膜通透性增加.这可以解释IAH与细菌易位以及脓毒症的关系.

Microscopic and ultrastructural changes of the intestine in abdominal compartment syndrome

Objective Direct damages that abdominal compartment syndrome(ACS) inflicts on intestinal mucosal barrier could be intestinal mucosal ischemia and dilatation of the intestinal tight junction(TJ).The purpose of the study was to examine the microscopic changes of intestinal villi and ultrastructural changes of TJ in the presence of intra-abdominal hypertension(IAH) of 20 mmHg,and to investigate the relationship of intestinal villus damage with ultrastructural changes of TJ and ACS.Methods Forty Sprague-Daley r...