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Deneysel laparoskopi modelinde pnömoperitonyuma bağlı akciğer hasarını önlemede magnezyumun etkisi

Yıl 2012, Cilt: 9 Sayı: 3, 92 - 98, 01.12.2012

Öz

Amaç: Laparaskopi açık cerrahiye göre minimal invaziv bir teknik olduğu düşünülmesine rağmen oluşturulan pnömoperitonyuma PP bağlı gelişen intraabdominal basınç İAB artışlarının özellikle abdominal organlarda hipoperfüzyona neden olabildiği gerek deneysel gerekse klinik çalışmalarla ortaya konulmuştur. Biz çalışmamızda deneysel laporoskopik modelde pnömoperitonyum sonrası oluşan akciğer hasarını önlemede MgSO4'ın etkisini ventile ettiğimiz ratlarda araştırdık. Materyal ve metod: Deney hayvanları olan 18 Srague-Dawley tipi dişi rat ağırlıkları 240-280 gr 3 gruba ayrıldı. Grup I n=6 : Ratlar sadece ventile edildi, pnömoperitonyum oluşturulmadı. Grup II n=6 : 12 mmhg basınç altında 60 dakika pnömoperitonyum oluşturuldu, Grup III n=6 : 12mmHg basınç ile 60 dakika PP maruz bırakıldı ve PP dan 30 dakika önce IP olarak 90 mg/kg dan MgSO4 verildi. Grup II ve III'den 60 dakika pnömoperitonyum ardından karın söndürüldükten 30 dakika sonra Grup I den ise 90 dakika ventile edildikten sonra kan ve akciğer doku örnekleri alındı. Plazmada iskemi modifiye albumin, malondealdehit düzeyi ölçüldü. Akciğer dokusu histopatolojik olarak incelendi.Bulgular: Plazmada çalışılan IMA düzeyleri Grup II' de diğer gruplara göre anlamlı derecede yüksek bulundu. MgSO4 verilen Grup III'de ise plazma IMA seviyelerinin pnömoperitonyum grubuna göre anlamlı ölçüde düştüğü bulundu. Histopatolojik incelemede Grup II' de iskemi reperfüzyon hasarına bağlı önemli değişiklikler gözlendi. Pnömoperitonyum grubuna ait preparatlarda yaygın interalveolar ve intraalveolar hemoraji, vasküler konjesyon ve alveolar ödem mevcut idi. Peribronşial inflamatuar hücre infiltrasyonu ve ayrıca alveolar yapıda belirgin dejenerasyon mevcut idi. Magnezyum sülfat grubuna ait doku kesitleri içeren preparatlarda ise alveolar hemoraji pnömoperitonyum grubuna göre belirgin düzeyde azalmıştı. Alveolar yapı normale yakın görünümde idi. Vasküler konjesyon orta düzeyde izlendi, pnömoperitonyum grubunda görülen alveolar ödem ise izlenmedi.Sonuç: Çalışmamızda ratlarda pnömoperitonyum sonrası gelişen iskemi reperfüzyona bağlı, akciğerde hasar oluştuğunu akciğerin histopatolojik incelenmesi ve oksidatif hasar belirteci olarak plazma IMA artışı ile tespit ettik. Sonuç olarak pnömoperitonyum nedeniyle gelişen akciğer hasarında MgSO4 verilmesinin iskemi reperfüzyona bağlı gelişen akciğer hasarını önlemede etkilerinin olabileceğini gösterdik

Kaynakça

  • ) Rosin D, Brassesco O, Varela J, et al. Low- pressure laparoscopy may ameliorate intracranial hypertension and renal hypoperfusion. J Laparoendosc Adv Surg Tech A 2002; 12: 15-9.
  • ) Schafer M, Krahenbuhl L. Effect of laparoscopy on intra-abdominal blood flow. Surgery 2001; 129: 9.
  • ) Eleftheriadis E, Kotzampassi K, Papanotas K, Heliadis N, Sarris K. Gut ischemia, oxidative stress and bacterial translocation in elevated abdominal pressure in rats. World J Surg 1996; 20: 11-6.
  • ) Polat C, Yilmaz S, Serteser M, Koken T, Kahraman A, Dilek ON. The effect of different intraabdominal pressures on lipid peroxidation and protein oxidation status during laparoscopic cholecystectomy. Surg Endosc 2003; 17: 1719-22.
  • ) Glantzounis GK, Tselepis AD, Tambaki AP, et al. Laparoscopic surgery-induced changes in oxidative stress markers in human plasma. Surg Endosc 2001; 15: 1315–9.
  • ) Bazargan M, Faghihi M, Chitsaz M. Importance of timing of magnesium administration in the isolated ischemic-reperfused rat heart: role of K (ATP) channels. Physiol Res 2008; 57: 839-46.
  • ) Bar-Or D, Curtis G, Rao N, Bampos N, Lau E. Characterization of the Co(2+) and Ni(2+) binding amino-acid residues of the N-terminus of human albumin. An insight into the mechanism of a new assay for myocardial ischemia. Eur J Biochem ; 268: 42–7. ) Windberger UB, Auer R, Keplinger F, et al. The role of intra-abdominal pressure on splanchnic and pulmonary hemodynamic and metabolic changes during carbon dioxide pneumoperitoneum. Gastrointest Endosc 1999; 49: 84-91.
  • ) Harman PK, Kron IL, McLachlin HD, et al. Elevated intra-abdominal pressure and renal function. Ann Surg 1982; 196: 594.
  • ) Sinha MK, Roy D, Gaze C, Collinson PO, Kaski C. Role of “Ischemia modified albumin”, a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emergency Medicine Journal 2004; 21: 29–34.
  • ) Sinha MK, Gaze DC, Tippins JR, Collinson PO, Kaski JC. Ischemia modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation 2003; 107: –5.
  • ) Erturk E, Cekic B, Geze S, et al. Comparison of the effect of propofol and N-acetyl cysteine in preventing ischaemia-reperfusion injury. Eur J Anaesthesiol 2009; 26: 279-84.
  • ) Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, Baxter GF. Role of reactive oxygen species on the formation of the novel diagnostic marker ischaemia modified albumin. Heart 2006; 92: –4.
  • ) Aran T, Unsal MA, Guven S, Kart C, Cetin EC, Alver A. Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study. Eur J Obstet Gynecol Reprod Biol 2011; 161: 80-3.
  • ) Kontoulis TM, Pissas DG, Pavlidis TE, et al. The O x i d a t i v e E f f e c t o f P r o l o n g e d C O ( 2 ) Pneumoperitoneum A Comparative Study in Rats. J Surg Res 2011; 175: 259-64.
  • ) Sare M, Hamamci D, Yilmaz I, et al. Effects of carbon dioxide pneumoperitoneum on free radical formation in lung and liver tissues. Surg Endosc ; 16: 188-92. ) James M.F.M.: Clinical use of magnesium infusions in anesthesia. Anesth Analg 1992; 74: 129
  • ) Hirata T, Fukuse, Ishikawa S, Miyahara R, Wada H. Addition of ATP and MgCl2 to the preservation solution attenuates lung reperfusion injury following cold ischemia. Respiration; international review of thoracic diseases 2001; 68: 292-8.
  • ) J Lin, S Chung, M Lin, F Cheng. Effects of magnesium sulfate on energy metabolites and glutamate in the cortex during focal cerebral ischemia and reperfusion in the gerbil monitored by a dual-probe microdialysis technique. Life sciences ; 71: 803-11. ) K Miyoshi, M Taniguchi, S Seki, S Mochizuki. Effects of magnesium and its mechanism on the incidence of reperfusion arrhythmias following s e v e r e i s c h e m i a i n i s o l a t e d r a t h e a r t s . Cardiovascular Drugs and Therapy 2000; 14: –33.
  • ) J TC Tzen,T Jınn, Y Chen. Magnesium lithospermate B possesses inhibitory activity on Na , + +K -ATPase and neuroprotective effects against ischemic stroke . Acta Pharmacologica Sinica 2007; : 609-15.

The preventive effect of magnesium sulfate on lung injury due to pneumoperitoneum in experimental laparoscopic model

Yıl 2012, Cilt: 9 Sayı: 3, 92 - 98, 01.12.2012

Öz

Background: Although laparoscopy was regarded as a minimally invasive technique compared to open surgery, experimental and clinical studies in recent years have revealed that rises in intra-abdominal pressure IAP in association with degree of pneumoperitoneum PP established may lead to hypoperfusion, particularly in the abdominal organs. Our purpose in this study was to investigate the effect of MgSO4 in preventing pulmonary injury after PP. Methods: Eighteen female Sprague-Dawley rats weight 240-280 g were divided into three groups. In Group I n=6 , rats were ventilated only, and no PP was established. In Group II n=6 , PP was established for 60 min under 12 mmHg pressure, while in Group III n=6 90 mg/kg MgSO4 was administered IP 30 min before 60-min PP at 12 mmHg. Blood and lung specimens from groups 2 and 3 were taken 30 min after abdominal desufflation following 60-min PP, and from Group 1 after 90-min ventilation. Plasma ischemia modified albumin IMA was measured. Lung tissue was examined histopathologically.Results: Plasma IMA levels were significantly higher in Group II compared to the other groups. Plasma IMA levels in Group III, administered MgSO4, decreased significantly compared to the PP group. Various significant reperfusion injury-related changes were observed at histopathological examination in Group II. Widespread inter- and intraalveolar hemorrhage, vascular congestion and alveolar edema were present in the PP group Group II preparates. Peribronchial inflammatory cell infiltration and pronounced degeneration in alveolar architecture were observed. Alveolar hemorrhage was significantly lower in the preparates containing tissue sections from the magnesium sulfate group Group III compared to the PP group. Alveolar architecture was close to normal. Vascular congestion was moderate, and the alveolar edema seen in the PP group was not observed.Conclusion: We determined that IR-related injury developing after PP causes injury in the lung in ventilated rats. IMA levels were significantly decreased in histopathological examination of lung tissue and in plasma. In conclusion the administration of MgSO4 in pulmonary injury arising due to PP may have important effects in reducing IR injury

Kaynakça

  • ) Rosin D, Brassesco O, Varela J, et al. Low- pressure laparoscopy may ameliorate intracranial hypertension and renal hypoperfusion. J Laparoendosc Adv Surg Tech A 2002; 12: 15-9.
  • ) Schafer M, Krahenbuhl L. Effect of laparoscopy on intra-abdominal blood flow. Surgery 2001; 129: 9.
  • ) Eleftheriadis E, Kotzampassi K, Papanotas K, Heliadis N, Sarris K. Gut ischemia, oxidative stress and bacterial translocation in elevated abdominal pressure in rats. World J Surg 1996; 20: 11-6.
  • ) Polat C, Yilmaz S, Serteser M, Koken T, Kahraman A, Dilek ON. The effect of different intraabdominal pressures on lipid peroxidation and protein oxidation status during laparoscopic cholecystectomy. Surg Endosc 2003; 17: 1719-22.
  • ) Glantzounis GK, Tselepis AD, Tambaki AP, et al. Laparoscopic surgery-induced changes in oxidative stress markers in human plasma. Surg Endosc 2001; 15: 1315–9.
  • ) Bazargan M, Faghihi M, Chitsaz M. Importance of timing of magnesium administration in the isolated ischemic-reperfused rat heart: role of K (ATP) channels. Physiol Res 2008; 57: 839-46.
  • ) Bar-Or D, Curtis G, Rao N, Bampos N, Lau E. Characterization of the Co(2+) and Ni(2+) binding amino-acid residues of the N-terminus of human albumin. An insight into the mechanism of a new assay for myocardial ischemia. Eur J Biochem ; 268: 42–7. ) Windberger UB, Auer R, Keplinger F, et al. The role of intra-abdominal pressure on splanchnic and pulmonary hemodynamic and metabolic changes during carbon dioxide pneumoperitoneum. Gastrointest Endosc 1999; 49: 84-91.
  • ) Harman PK, Kron IL, McLachlin HD, et al. Elevated intra-abdominal pressure and renal function. Ann Surg 1982; 196: 594.
  • ) Sinha MK, Roy D, Gaze C, Collinson PO, Kaski C. Role of “Ischemia modified albumin”, a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emergency Medicine Journal 2004; 21: 29–34.
  • ) Sinha MK, Gaze DC, Tippins JR, Collinson PO, Kaski JC. Ischemia modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation 2003; 107: –5.
  • ) Erturk E, Cekic B, Geze S, et al. Comparison of the effect of propofol and N-acetyl cysteine in preventing ischaemia-reperfusion injury. Eur J Anaesthesiol 2009; 26: 279-84.
  • ) Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, Baxter GF. Role of reactive oxygen species on the formation of the novel diagnostic marker ischaemia modified albumin. Heart 2006; 92: –4.
  • ) Aran T, Unsal MA, Guven S, Kart C, Cetin EC, Alver A. Carbon dioxide pneumoperitoneum induces systemic oxidative stress: a clinical study. Eur J Obstet Gynecol Reprod Biol 2011; 161: 80-3.
  • ) Kontoulis TM, Pissas DG, Pavlidis TE, et al. The O x i d a t i v e E f f e c t o f P r o l o n g e d C O ( 2 ) Pneumoperitoneum A Comparative Study in Rats. J Surg Res 2011; 175: 259-64.
  • ) Sare M, Hamamci D, Yilmaz I, et al. Effects of carbon dioxide pneumoperitoneum on free radical formation in lung and liver tissues. Surg Endosc ; 16: 188-92. ) James M.F.M.: Clinical use of magnesium infusions in anesthesia. Anesth Analg 1992; 74: 129
  • ) Hirata T, Fukuse, Ishikawa S, Miyahara R, Wada H. Addition of ATP and MgCl2 to the preservation solution attenuates lung reperfusion injury following cold ischemia. Respiration; international review of thoracic diseases 2001; 68: 292-8.
  • ) J Lin, S Chung, M Lin, F Cheng. Effects of magnesium sulfate on energy metabolites and glutamate in the cortex during focal cerebral ischemia and reperfusion in the gerbil monitored by a dual-probe microdialysis technique. Life sciences ; 71: 803-11. ) K Miyoshi, M Taniguchi, S Seki, S Mochizuki. Effects of magnesium and its mechanism on the incidence of reperfusion arrhythmias following s e v e r e i s c h e m i a i n i s o l a t e d r a t h e a r t s . Cardiovascular Drugs and Therapy 2000; 14: –33.
  • ) J TC Tzen,T Jınn, Y Chen. Magnesium lithospermate B possesses inhibitory activity on Na , + +K -ATPase and neuroprotective effects against ischemic stroke . Acta Pharmacologica Sinica 2007; : 609-15.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Makalesi
Yazarlar

Fatih Yörük Bu kişi benim

Şükran Geze Bu kişi benim

Mustafa Tusat Bu kişi benim

Ahmet Menteşe Bu kişi benim

Esin Yuluğ Bu kişi benim

Emre Beyaztaş Bu kişi benim

Ahmet Alver Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2012
Yayımlandığı Sayı Yıl 2012 Cilt: 9 Sayı: 3

Kaynak Göster

Vancouver Yörük F, Geze Ş, Tusat M, Menteşe A, Yuluğ E, Beyaztaş E, Alver A. Deneysel laparoskopi modelinde pnömoperitonyuma bağlı akciğer hasarını önlemede magnezyumun etkisi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2012;9(3):92-8.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty