重症急性胰腺炎早期体液代谢特点及机制

目的 探讨重症急性胰腺炎早期体液代谢的特点和机制.方法 取杂种犬23条分两组:轻症急性胰腺炎组(MAP组)8条和重症急性胰腺炎组(SAP组)5条,采用自身胆汁逆行主胰管注射法制模.制模后第1～5天每日补液,测定血浆Na+、K+、红细胞压积(HCT)、血浆醛固酮激素(ALD)和血管紧张素Ⅱ(AngⅡ)水平,记录总人量、总出量和体液隔离量.结果 SAP组K离子浓度变化不明显,Na离子浓度在制模后第1天升高,从第2天开始下降;SAP组在6 d实验过程中出量均小于入量,MAP组在第3天出量开始大于入量;SAP组体液隔离量在48 h和72 h持续增加,分别为(1341±373)ml和(1998±510)ml,与MAP组比较差异有统计学意义(P<0.05);SAP组制模后第1天血浆ALD水平和AngⅡ水平升高,与MAP组比较差异有统计学意义(P<0.05),在第2、3天有下降,但仍高于制模前水平.结论 SAP早期体液代谢紊乱主要集中在容量和浓度方面,表现为出量显著少于入量和体液隔离量持续增加;肾脏排出功能下降使其不能发挥体液调节作用可能是SAP体液代谢紊乱的中心环节.

Experimental study on the characteristic and mechanism of body fluid metabolism in acute reaction phase of severe acute pancreatitis

Objective To study the characteristic and mechanism of fluid metabolism in acute re-action phase of the severe acute pancreatitis (SAP). Methods Twenty-three dogs were randomly divided into two groups:mild acute pancreatitis (MAP) group (n=8) and SAP group (n= 15).The model of a-cute pancreatitis was made by injecting bile into main pancreatic duct. All the dogs were subjected to infu-sion therapy 1-5 days after model establishment. The plasma concentrations of Na+ and K+ ,red cell bema-tocrit,the plasma levels of aldosterone hormone and angiotensin Ⅱ were measured. The total incoming and excreting fluid and the total amount of isolation fluid were recorded. Results K+ concentration in SAP group had no significant change,and Na+ concentration was increased to (152.8±5.2) mmol/L at the first day ,decreased on the second day. The fluid output of 15 dogs was leas than the fluid input during the experiment period,and fluid sequestration at 48 h and 72 h was (1341±373) ml and (1998±510) ml respectively. There was significant difference between MAP and SAP groups (P < 0.05). The levels of plasma ALD and Ang Ⅱ were increased significantly in SAP group at the first day after the operation as compared with MAP group (P < 0.05). Both of them were declined at the second and third day, but higher than those preoperation. Conclusion The early body fluids metabolic disorder of the SAP mainly concen-trates in the capacity and concentration. The amount of the output is remarkably less than that of the input and fluid sequestration is increased continuously. The decline of the renal excretion function, which cannot play a fully role in regulating fluid metabolism,may be the key in metabolic disorder.