气腹对肝硬化大鼠肝脏血流的影响

目的：探讨气腹压力下正常机体及肝硬化机体肝脏吲哚青绿排泄的变化及气腹对肝脏血流的影响。方法：雄性Wistar大鼠30只,随机分成5组,其中2组用60％四氯化碳皮下注射加5％乙醇口服的方法建立肝硬化模型。同期对5组进行吲哚青绿15min排泄试验：正常麻醉组、正常开腹组、正常气腹组、肝硬化麻醉组、肝硬化气腹组。结果：5组分别测得血清吲哚青绿含量,正常开腹组（0．662μg/ml）虽高于正常麻醉组（0．645μg/ml）,但差异无显著意义（P＞0．05）;正常气腹组（0．967μg/ml）显著高于麻醉组及开腹组（P＜0．05）;而肝硬化麻醉组（1．198μg/ml）和肝硬化气腹组（1．348μg/ml）均显著高于正常3组（P＜0．05）;肝硬化气腹组又显著高于肝硬化麻醉组（P＜0．05）。结论：气腹使吲哚青绿排泄降低的结果,证实了腹腔镜手术中的气腹压力可减少肝脏血流量,对于肝硬化机体更有临床意义。

Effect of pneumoperitoneum on the liver blood flow in cirrhotic rats

OBJECTIVE: To determine the effect of pneumoperitoneum on liver indocyanine green (ICG) metabolism and the hepatic blood flow in normal and cirrhotic rats. METHODS: Thirty male Wistar rats were randomized into five groups: normal anaesthesia group, normal laparotomy group, normal pneumoperitoneum group, cirrhosis + anaesthesia group, and cirrhosis + pneumoperitoneum group. Liver cirrhosis was induced in two groups by injecting carbon tetrachloride subcutaneously plus drinking 5% alcohol. ICG clearance tests were performed in all the rats. RESULTS: The ICG level in the normal laparotomy group (0.662 micro g/ml) was higher than that in the normal anesthesia group (0.645 micro g/ml), but the difference was not significant (P > 0,05). The ICG level in the normal pneumoperitoneum group (0.967 micro g/ml) was significantly higher than that in the normal anesthesia and normal laparotomy groups (P < 0.05). The ICG levels in two cirrhotic groups were significantly higher than those in the other three groups (P < 0.05). The ICG level in the cirrhosis + pneumoperitoneum (1.348 micro g/ml) was significantly higher than that in the cirrhosis + anesthesia group (1.198 micro g/ml) (P < 0.05). CONCLUSIONS: During laparoscopic surgery, pneumoperitoneum could decrease the liver ICG clearance rate and the hepatic blood flow, which are of clinical significance in determining the state of liver cirrhotic.