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目的:建立一个重症感染后多器官功能障碍综合征(MODS)并急性肾衰竭(ARF)复合的猪模型。方法:16只健康杂交家猪随机分成模型组和假手术对照组。模型组行盲肠结扎和穿孔(CLP),加作肾动脉夹闭(CRA)制作腹腔感染致MODS并ARF模型,对照组行盲肠和双肾探查术。观察生命体征及主要器官功能(MODS相关指标)变化。结果:模型组术后24～72h出现器官功能障碍:(1)ARF:血清肌酐(Scr)、尿素氮(BUN)分别从(92.70±11.05)μmol/L、(4.16±1.02)mmol/L升至(986.37±132.61)μmol/L、(48.13±2.68)mmol/L。(2)肝功能:血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)均超过对照值的2倍;(3)凝血功能:血小板数<80%对照值,且皮肤可见弥漫或散在的出血点;(4)心功能:平均动脉压(MAP)持续≤70%对照值,且呈进行性下降;心率≥130次/min;(5)肺功能:动脉血二氧化碳分压(PaO2)下降,低于69.75mmHg;呼吸频率增快,均值超过照值的2倍;(6)胃肠功能障碍;(7)肾、肝、脾、肺及小肠等器官组织病理上均有不同程度的实质性改变。模型组动物6d内全部死亡,平均存活时间(69.81±22.59)h;对照组全部存活,且器官功能无明显变化。结论:采用CLP+CRA方法,可以成功地复制出MODS并ARF复合模型,并可见最终均发展为多器官衰竭。
Objective: To establish a porcine model of multiple organ dysfunction syndrome (MODS) combined with acute renal failure (ARF) after severe infection. Methods: Sixteen healthy crossbred domestic pigs were randomly divided into model group and sham operation control group. The model group was subjected to cecal ligation and puncture (CLP), plus renal artery occlusion (CRA) for MODS and ARF models. The control group received cecal and double renal exploration. Vital signs and major organ function (MODS related indicators) changes were observed. Results: The organ dysfunction occurred at 24 ~ 72h after operation in model group. (1) ARF: Serum creatinine (Scr) and blood urea nitrogen (BUN) increased from 92.70 ± 11.05μmol / L to 4.16 ± 1.02mmol / (986.37 ± 132.61) μmol / L and (48.13 ± 2.68) mmol / L, respectively. (2) Liver function: Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were more than twice of the control value; (3) coagulation function: platelet count <80% of the control value, (4) heart function: mean arterial pressure (MAP) continued to be less than 70% of the control value, and showed a progressive decline; heart rate ≥130 beats / min; (5) pulmonary function: arterial partial pressure of carbon dioxide ) Decreased, less than 69.75mmHg; respiratory rate increased faster than the average value of 2 times; (6) gastrointestinal dysfunction; (7) kidney, liver, spleen, lung and small intestine and other organs were histologically different degrees The substantial change. The model group all died within 6 days, the average survival time (69.81 ± 22.59) h; control group all survived, and no significant changes in organ function. Conclusion: The combined model of MODS and ARF can be successfully replicated by using CLP + CRA method, and eventually all develop into multiple organ failure.