Περιφερικοί δείκτες βαρύτητας εντερικής ισχαιμίας: πειραματική μελέτη επί κονίκλων

Abstract

Acute intestinal ischemia is a life threatening situation, if it is not recognized at an early stage. Common causes of ischemia, such as arterial occlusion, normally affect a large part, if not the entire length, of the small intestine and produce loud symptoms, thus facilitating the diagnostic approach. On the other hand other causes of intestinal ischemia of extravascular origin influence smaller segments of the small intestine and produce milder or vague clinical symptoms delaying the diagnosis sometimes until the affected intestine is no longer viable or until perforation occurs. Extravascular causes of intestinal ischemia that are commonly seen in surgical patients include hernias, adhesive bands, intussusception and small intestine obstructive ileus. The aim of our study was to investigate the possible value of serum Endothelin -1 (ET-1), Magnesium (Mg), inorganic Phosphorus (iP), Nitrogen monoxide (NO), transaminases (AST,ALT) and Creatinine Kinase (CPK) concentrations, as well as the white blood cell count (WBC) as early markers of intestinal ischemia in an animal model of intestinal strangulation. An animal model of intestinal strangulation obstruction was used. Seventeen animals were included, eleven of which were subjected to intestinal strangulation while six animals were subjected to a sham laparotomy as a control group. ET-1, Mg, iP, NO, CPK, AST, ALT concentrations and WBC count in peripheral blood samples were determined preoperatively and after 30, 60, 180 and 360 min of ischemia or the sham operation respectively. At the same time intervals transmural biopsies from the affected intestinal loop were obtained to establish the extend of ischemic injury. The analysis showed that the increase of ET-1 and iP levels were statistically significant (p<0,05) at every time interval, whereas AST, ALT and Mg levels were significantly elevated (p<0.05) after 360 min of ischemia compared to the baseline in the strangulation group, whereas the variations in the control group were not of statistical significance. Analysis of ET-1, iP, Mg, AST and ALT plasma concentrations between the strangulation and the control group at the time intervals were increase was significant revealed statistically significant differences (p<0,05) between the two groups. Evaluating the results of our study, we can assume that ET-1, Mg, iP, AST, and ALT concentrations per se or in combination might be reliable markers for the early diagnosis of ischemia in cases of intestinal strangulation - obstruction. They may also contribute to the evaluation of the progress of ischemic injury by consequent measurements.

Σκοπός αυτής της διδακτορικής διατριβής, η οποία έγινε σε πειραματικό πρότυπο στραγγαλισμού του λεπτού εντέρου σε κονίκλους, αποτελεί η μελέτη των αρχικών παθοφυσιολογικών μεταβολών, τόσο τοπικά όσο και συστηματικά, που προκύπτουν από την έναρξη της ισχαιμίας μέχρι την νέκρωση του εντέρου, σε μια προσπάθεια αναγνώρισης βιοχημικών και αιματολογικών παραμέτρων, που θα μπορούσαν να συνδράμουν στην πρώϊμη διάγνωση της νόσου. Επίσης τα ευρήματα αυτά, σε συνδυασμό με την ιστολογική και ανοσοϊστοχημική μελέτη ολοτοιχωματικών βιοψιών του εντέρου κατά την διάρκεια της χρονικής εξέλιξης του φαινομένου, θα μπορούσαν να αποτελέσουν χρήσιμο βοήθημα όχι μόνο για την τεκμηρίωση των ισχαιμικών αλλοιώσεων, αλλά και για την εκτίμηση της βαρύτητας της βλάβης και της βιωσιμότητας του οργάνου.