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Free Paper 通過 以豬隻實驗建立病理模式腹腔高壓症
Pilot Study of Abdominal Compartment Syndrome --- A pathologic porcine model of intra-abdominal hype
Purpose: Abdominal compartment syndrome (ACS) had been simulated in many animal models with installation of fluid, air or water bag in peritoneal cavity, and the damage effects of intra-abdominal hypertension (IAH) to systemic circulation and intra-abdominal organs had been studied well. But, few animal models were set up according to the real mechanism happened in patients. In order to evaluate the pathophysiology of ACS and efficacy of therapeutic approach, development of a pathological animal model is necessary. Effective and easily built animal model is our purpose for this pilot study. Methods: Twelve healthy domestic piglets weighing 24.1±1.2 Kg underwent general endotracheal anesthesia. Pulmonary arterial catheterization, arterial pressure catheterization, inferior vena cava catheterization, electrocardiogram, urinary catheterization and intra-vesical intra-abdominal pressure (IAP) monitor were set up before beginning the intervention procedures. A 9F Pruitt® irrigation occlusion catheter was placed into abdomen aorta through left common femoral artery. Baseline hemodynamic data, peak airway pressure, IAP, arterial blood gas analysis, and biochemistry data were collected. Reperfusion injury of intra-abdominal organs was done by occlusion of upper abdomen aorta with irrigation occlusion catheter for 30 minutes (group A, n=4), 60 minutes (group B, n=4) and 120 minutes (group C, n=4) separately. After observation for 20 hours, hemodynamic data, peak airway pressure, IAP, arterial blood gas analysis, biochemistry data were statistically analyzed. The kidney, lung and small intestine were procured for histological diagnosis after the piglets died or were sacrificed at the 20th hours after reperfusion. All values are represented as mean±SD. Paired t test was applied to test the difference of value at each time point from the baseline. The trend between variables and reperfusion time was evaluated by multivariable regression model. The histological parameters were compared by analysis of variance on ranks followed by Kruskal Wallis test. Results: All pigs (n=12, weighing 24.1±1.2 Kg) developed IAH gradually after ischemia/reperfusion injury. Two pigs expired during the first 12 reperfusion hours. One pig expired at the 8th hour in group B, and the other pig expired at 4th hour in group C. The IAP increased significantly after reperfusion for 4 hours. (p = 0.028) And, the maximal IAP could reach more than 22 mmHg in 10 pigs. There was no significant difference of slope between group B and A, or C and A. SVO2 deteriorated significantly since the 8th reperfusion hour. (p=0.034) CVP increased gradually and statistical difference significantly since the 16th perfusion hour. (p=0.043) There were no trend differences among groups. The BUN and Cr showed not significant change in group A and B, but the data increased significantly in group C after 12th and 8th reperfusion hours. Semiquantitative analysis of histological changes of the small intestine was not significant among the groups. The alveolar tissue of lung showed congestion and atelectasis. The parenchyma tissue of kidney showed edematous change at epithelium of renal tubules. Conclusion: This animal model is feasible and reproducible. The use of aortic occlusion balloon to introduce reperfusion injury imitates the pathological effects on patients but not make destruction of abdominal wall architecture. Occlusion of upper abdominal aorta for 30 min may produce an animal model of intra-abdominal hypertension greater than 20 mmHg within 20 hours, which may apply on the evaluation of pharmaceutical therapy or surgical intervention for ACS. Key words: Porcine model, intra-abdominal hypertension, abdominal compartment syndrome, ischemia-reperfusion injury