二氧化碳气腹对幼兔肝肾功能影响的实验研究

目的 观察CQ气腹对幼兔肝肾功能的影响,为临床新生儿腹腔镜外科气腹的选择提供参考.方法 32只健康新西兰幼兔(3周龄,体重0.8～1.0 kg)按随机数字表法平均分为4组:对照组(单纯腹腔麻醉)、开腹手术组(麻醉后行开腹手术)、低压力组(腹腔压力维持在6 mmHg)、高压力组(腹腔压力维持在12 mmHg),采用10％水合氯醛3ml/kg腹腔麻醉,术中追加用4％水合氯醛1 ml.麻醉时间持续4h.麻醉4h后每组随机取4只处死,余4只复苏后继续饲养7d后处死,均切取肝肾组织浸泡福尔马林,行HE染色,观察组织学改变.分别于麻醉前30 min、麻醉后4h及术后7d取幼兔静脉血3 ml,-80℃保存.收集血清,进行肝肾生化指标检测,包括:谷丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)、谷氨酰转肽酶(GGT)、肌酐(CR)、尿素氮(BUN)和尿酸(UA).结果 四组幼兔麻醉前和麻醉后4h、术后7d血清CR、BUN、UA、AST、TBIL及DBIL变化差异均无统计学意义(P＞0.05).气腹高压力组麻醉后4h和术后7d血清ALT值分别为(81.24 U/L,59.87 U/L),两者相比,差异无统计学意义(P＞0.05);与本组麻醉前30 min(8.14 U/L)比较,差异有统计学意义(P＜0.05);且与对照组、开腹手术组及气腹低压力组麻醉后4h血清ALT值(8.50、9.09和9.40 U/L)及术后7d血清ALT值(13.07、8.58和12.83 U/L)比较,差异有统计学意义(P＜0.05).气腹高压力组麻醉后4h和术后7d血清GGT值分别为193.72 U/L和156.74 U/L,两者比较,差异无统计学意义(P＞0.05);与本组麻醉前30 min血清GGT值14.85 U/L比较,差异有统计学意义(P＜0.05);且与对照组、开腹手术组及气腹低压力组麻醉后4h血清GGT值(20.31、15.11和15.98 U/L)及术后7d血清GGT值(22.26、14.70和27.44 U/L)比较,差异有统计学意义(P＜0.05).HE染色显示高压组幼兔麻醉后4h和术后7d均可见弥漫肝淤血,且术后7d无明显改善,肾无明显组织形态学改变.结论 幼兔可良好耐受6 mmHg和12 mmHg的气腹压力,术后可存活.气腹压力为6 mmHg时肝肾功能均不受显著影响,12 mmHg时肾功能影响不显著,但肝出现了肝淤血改变,且术后7d无明显恢复.

Effects of laparoscopic carbon dioxide pneumoperitoneum on functions of liver and kidney in infant rabbits

Objective To explore the effects of different carbon dioxide pneumoperitoneal pressure on functions of liver and kidney in infant rabbits so as to provide rationales for clinical neonatal laparoscopy.Methods A total of 32 healthy young rabbits (3-week-old,0.8-1.0 kg) were equally and randomly divided into control group (abdominal anesthesia only),operative group (abdomen anesthesia plus laparotomy) and 6 mmHg and 12 mmHg groups (abdominal anesthesia plus carbon dioxide pneumoperitoneurn maintaining the pressures of 6 mmHg and 12 mmHg).And 10％ chloral hydrate 3 ml/kg was injected into abdomen for anesthesia and 4％ chloral hydrate 1ml for confirming the effect of anesthesia.Anesthetic time lasted for 4 hours.After closure,half of them were sacrificed and harvested venous blood,liver and kidney harvested.Half of rabbits in each group underwent anesthetic recovery and survived for 7 more days.Blood samples were collected before anesthesia (T0),4 hours post-anesthesia (T1) and 7 days (T2).Tissues were fixed with 10％ formalin and prepared into slices with hematoxylin & eosin (HE) staining for observations under optical microscope.The serum levels of alanine amino acid transaminase (ALT),aspartate aminotransferase (AST),total bilirubin (TBIL),direct bilirubin (DBIL),glutamine transferase (GGT),creatinine (CR),urea nitrogen (BUN) and uric acid (UA) were detected.Results The serum levels of AST,TBIL,DBIL,CR,BUN and UA showed changes of no statistical significance at T0,T1 and T2 in four groups.The ALT levels at T1 and T2 in high pressure group were (81.24 U/L,59.87 U/L) respectively and there was no significant inter-group difference (P＞ 0.05).However,they were significantly higher than that at T0 (8.14 U/L) (P＜0.05).As compared with ALT levels at T1 in control group,open surgery group and low pressure group (8.50,9.09,9.40 U/L) and T2 (13.07,8.58,12.83 U/L),they were also significantly significant (P＜0.05).The GGT levels at T1 and T2 in high pressure group were (193.72,156.74 U/L) respectively and there was no significant inter-group difference (P＞0.05).However,they were significantly higher than those at T0 (14.85 U/L)(P＜ 0.05).Besides,as compared with ALT levels at T1 in control,open surgery and low pressure groups (20.310,15.11,15.980 U/L) and T2 (22.26,14.70,27.44 U/L),they were also significantly significant (P＜0.05).HE staining showed diffuse liver congestion in high pressure group at 4 hours after anesthesia and showed no obvious improvement in 7 days.No obvious morphological change was seen in kidney.Conclusions Immature rabbits have an excellent tolerance for 6 mmHg and 12 mmHg pneumoperitoneal pressure.Kidney function has no obvious change in low pressure and high pressure groups.But 12 mmHg pneumoperitoneal pressure has greater effect on liver function.Diffuse liver congestion may be detected pathologically and there is no apparent improvement in 7 days.