Animal Experiments And Clinical Studies In Hepatic Ischemia Reperfusion Injury Accompany With Intra-abdominal Hypertension

Part 1.Establishment of Rats’ Models with Hepatic Ischemia Reperfusion Injury accompany with Intra-abdominal HypertensionObjective To establish rats’ models with hepatic ischemia reperfusion injury accompany with intra-abdominal hypertension.To collect the base data of intra-abdominal pressure arround operation time.Method We split whole process into two steps.Step 1,we established rats’ models of hepatic ischemia reperfusion injury.Step 2,we put the intra-abdominal pressure adjust water balloon into rats’ abdominal.We choice health SD rats whose weight between 220-250g.Preliminary pilot study was performed in 4 groups of SD rats that every group has 50 rats.We defined team as S1,S2,S3 and Control.The mean object is to establish rats’ models of hepatic ischemia reperfusion injury.We collected each team’s operation time,hepatic ischemia time,success rate of operation,postoperative survival rate 8h after operation.Prospective success rate of operation should greater than or equal 90%.After that,we put the intra-abdominal pressure adjust water balloon into rats’ abdominal,with this method,we established 4 experimental groups named IAH-10,IAH10-R,IAH-20,IAH20-R.We collected same data from 4 experimental groups.At last,we compared all data between Control group and all the groups’ pairs.We analyzed data with SPSS 19.0 software.P=0.05.Result Compared with Control group.S1 and S2 groups’ operation time were longer than Control group.P<0.05.S3 group’s operation time was as the same as Control group.P>0.05.IAH-10,IAH10-R,IAH-20,IAH20-R groups’ operation time were as the same as Control group.P>0.05.S1 and S2 groups’ hepatic ischemia time were longer than Control group.P<0.05.S3 group’s hepatic ischemia time was as the same as Control group.P>0.05.IAH-10,IAH10-R,IAH-20,IAH20-R groups’ hepatic ischemia time were as the same as Control group.P>0.05.Compared with Control group.S1 and S2 groups’ success rate of operation were lower than Control group.P<0.05.S3 group’s success rate of operation was as the same as Control group.P>0.05.IAH-10,IAH10-R,IAH-20,IAH20-R groups’ success rate of operation were as the same as Control group.P>0.05.S1,S2,IAH-20 and IAH20-R groups’postoperative survival rate 8h after operation were lower than Control group.Conclusion We found an easy method that only need to block portal vein,suprahepatic inferior vena cava,infrahepatic inferior vena cava,hepatic artery.After that,we ligated left phrenic vein,right adrenal venous and splenic vein.At last,we put the intra-abdominal pressure adjust water balloon into rats’ abdominal.It was easy to establish rats’ models of hepatic ischemia reperfusion injury accompany with intra-abdominal hypertension.Part 2.Hepatocellular Function,Humoral Immunity and Hepatocyte Apoptosis in Hepatic Ischemia Reperfusion Injury accompany with Intra-abdominal Hypertension Rats’ ModelsObjective After the hepatic ischemia reperfusion injury accompanied with intra-abdominal hypertension rats’models was established.We observed success rate of operation and survival rate of the rats.We observed TBIL,ALT,AST,TNF-α,IL-1β,IL-2,IL-10,IL-12 level in different intra-abdominal pressure based on hepatic ischemia reperfusion injury rats’ teams.We observed hepatocellular necrosis and hepatocellular apoptosis in different rats’ teams.Method We established 5 teams included Control(hepatic ischemia reperfusion injury only),IAH-10(hepatic ischemia reperfusion injury accompanied 10mmHg intra-abdominal pressure),IAH10-R(hepatic ischemia reperfusion injury accompanied 10mmHg intra-abdominal pressure for 4h after operation,then released the pressure),IAH-20(hepatic ischemia reperfusion injury accompanied 20mmHg intra-abdominal pressure),IAH20-R(hepatic ischemia reperfusion injury accompanied 20mmHg intra-abdominal pressure for 4h after operation,then released the pressure).We compared success rate of operation(χ2)and survival rate(Kaplan-Meier method)of the rats.We collected blood samples from rats at the existing time:before operation,just after operation,2h after operation,4h after operation,6h after operation,8h after operation.We compared TBIL,ALT,AST,TNF-a,IL-1β,IL-2,IL-10,IL-12 level in different teams tested by ELISA technics.We observed hepatocellular necrosis(HE staining)and hepatocellular apoptosis(Tunel method)in different rats’ teams.We analyzed data with SPSS 19.0.P=0.05.Result There was no difference in operation success rate in different rats’ teams(P>0.05).The survival rate in IAH-20 and IAH20-R was lower than other teams’(P<0.05).Before operation blood sample test:there were no difference in TBIL,ALT,AST,TNF-a,IL-1β,IL-2,IL-10,IL-12 level in different teams(P>0.05).Just after operation blood sample test:there were no difference in TBIL,ALT,AST,TNF-a,IL-1β,IL-2,IL-10,IL-12 level in different teams(P>0.05).2h after operation blood sample test:TBIL:IAH-20(16.4±1.μmol/L)&Cnotrol(15.77±1.0μmol/L)(t=-2.760;95%CI:-1.469～-0.237;P=0.007);IAH20-R(16.7±1.5μmol/L)&Cnotrol(15.7±1.0μmol/L)(t=-3.349;95%CI:-1.754～-0.446;P=0.001);IAH-10(15.7±1.0μmol/L)&IAH-20(16.4±1.3μmol/L)(t=-2.731;95%CI:-1.302～-0.203;P=0.008);IAH10-R(15.99±1.1μmol/L)&IAH20-R(16.7±1.5μmol/L)(t=-2.524;95%CI:-1.386～-0.163;P=0.014).ALT:IAH-20(154.1±11.5 IU/L)&Cnotrol(128.1±11.1 IU/L)(t=-9.816;95%CI:-31.242～-20.696;P=0.000);IAH20-R 组(155.1±12.8 IU/L)&Cnotrol(128.1±11.1 IU/L)(t--9.882;95%CI:-32.441～-21.556;P=0.000);IAH-10(130.4±10.6 IU/L)&IAH-20(154.1±11.5 IU/L)(t=-9.061;95%CI:-28.906～-18.477;P=0.000);IAH10-R(131.1±9.5 IU/L)&IAH20-R(155.1±12.8 IU/L)(t=-9.169;95%CI:-29.247～-18.798;P=0.000).AST:IAH-20(585.3±43.7 IU/L)&Cnotrol(487.2±42.3 IU/L)(t=-9.756;95%CI:-118.147～-78.064;P=0.000);IAH20-R(589.6±48.7 IU/L)&Cnotrol(487.2±42.3 IU/L)(t=-9.863:95%CI:-123.146～-81.758;P=0.000);IAH-10(495.6±40.0 IU/L)&IAH-20(585.3±43.7 IU/L)(t=-9.039;95%CI:-109.411～-69.858;P=0.000);IAH10-R(498.2±36.5 IU/L)&IAH20-R(589.6±48.7IU/L)(t=-9.162;95%CI:-111.330～-71.534;P=0.000).TNF-a:IAH-20(295.0±6.2 ng/L)&Cnotrol(266.7±5.7 ng/L)(t=-20.472;95%CI:-31.023～-25.519;P=0.000);IAH20-R(295.9±8.0 ng/L)&Cnotrol(266.7±5.7 ng/L)(t=-18.674;95%CI:-32.318～-26.088;P=0.000);IAH-10(266.8±6.1 ng/L)&IAH-20(295.0±6.2 ng/L)(t=-19.297;95%CI:-31.123～-25.292;P=0.000);IAH10-R(267.6±6.0 ng/L)&IAH20-R(295.0±6.2 ng/L)(t=17.190;95%CI:25.023～31.590;P=0.000).IL-1β:There was no difference in all the rats’ teams.(P>0.05).IL-2:There was no difference in all the rats’ teams.(P>0.05).IL-10:IAH-20(22.13±5.00μg/L)&Cnotrol(25.35±5.85μg/L)(t=2.493;95%CI:0.647～5.802;P=0.015);IAH20-R(23.01±3.59μg/L)&Cnotrol(25.35±5.85μg/L)(t=2.033;95%CI:0.048～4.643;P=0.046):IAH-10(25.92±5.97μg/L)&IAH-20(22.13±5.00μg/L)(t=52.858;95%CI:1.144～6.438;P=0.006);IAH10-R(25.06±4.45μg/L)&IAH20-R(23.01±3.59μg/L)(t=-2.140;95%CI:-3.970～-0.140;P=0.036).IL-12:IAH-10(82.71±5.56μg/L)&IAH-20(85.63±5.06μg/L)(t=0.734;95%CI:-5.458～-0.377;P=0.025);IAH10-R(81.88±6.78μg/L)&IAH20-R(88.24±15.92μg/L)(t=-2.288;95%CI:0.871～11.894;P=0.025).4h after operation blood sample test:TBIL:IAH-20(24.9±2.4μmol/L)&Cnotrol(20.4±1.3μmol/L)(t=-8.768;95%CI:-5.612～-3.522;P=0.000);IAH20-R(25.5±2.7μmol/L)&Cnotrol(20.4±1.3μmol/L)(t=-9.398;95%CI:-6.236～-4.042;P=0.000);IAH-10(20.4±1.3μmol/L)&IAH-20(24.9±2.4μgmol/L)(t=-8.411;95%CI:-5.578～-3.426;P=0.000);IAH10-R(20.77±1.4μmol/L)&IAH20-R(25.5±2.7μmol/L)(t=-8.556;95%CI:-5.968～-3.699;P=0.000).ALT:IAH-20(324.77±17.0 IU/L)&Cnotrol(222.99±19.3 IU/L)(t=-17.019;95%CI:-113.859～-89.841;P=0.000);IAH20-R(315.0±27.5 IU/L)&Cnotrol(222.9±19.3 IU/L)(t=-13.771;95%CI:-105.548～-78.711;P=0.000);IAH-10(227.7±19.1 IU/L)&IAH-20(324.7±17.0 IU/L)(t=-16.202;95%CI:-109.077～-85.005;P=0.000);IAH10-R(229.4±15.8 IU/L)&IAH20-R(315.0±27.5IU/L)(t=-14.125;95%CI:-97.721=-73.400;P=0.000).AST:IAH-20(1234.0±64.8 IU/L)&Cnotrol(824.5±71.4 IU/L)(t=-18.400;95%CI:-454.171～-364.850;P=0.000);IAH20-R(1196.5±104.4 IU/L)&Cnotrol(824.5±71.4 IU/L)(t=-14.881;95%CI:-422.183～-321.891;P=0.000);IAH-10(841.7±69.9 IU/L)&IAH-20(1234.0±64.8 IU/L)(t=-17.783;95%CI:-436.538～-347.892;P=0.000);IAH10-R(848.9±58.3 IU/L)&IAH20-R(1196.5±104.4 IU/L)(t=-15.302;95%CI:-393.139～-301.944;P=0.000).TNF-a:IAH-20(361.9±23.5ng/L)&Cnotrol(341.8±7.9 ng/L)(t=-4.778;95%CI:-28.520～-11.649;P=0.000);IAH20-R(366.4±20.1 ng/L)&Cnotrol(341.8±7.9 ng/L)(t=-6.617;95%CI:-32.083～-17.158;P=0.000);IAH-10(341.7±8.5 ng/L)&IAH-20(361.9±23.5 ng/L)(t=-4.554;95%CI:-29.077～-11.271;P=0.000);IAH10-R(343.0±8.2ng/L)&IAH20-R(366.4±20.1 ng/L)(t=-6.102;95%CI:15.737～31.170;P=0.000).IL-1β:There was no difference in all the rats’ teams.(P>0.05).IL-2:There was no difference in all the rats’ teams.(P>0.05).IL-10:IAH-20(118.19±26.88μg/L)&Cnotrol(143.55±34.37μg/L)(t=-2.429;95%CI:4.411～46.297;P=0.019);IAH20-R(122.31±16.41μg/L)&Cnotrol(143.55±34.37μg/L)(t=-2.218;95%CI:2.029～40.452;P=0.031);IAH-10(147.51±34.64μg/L)&IAH-20(118.19±26.88μg/L)(t=2.772;95%CI:8.063～50.563;P=0.008);IAH10-R(140.19±26.01μg/L)&IAH20-R(122.31±16.4μgg/L)(t=--2.398;95%CI:-32.854～-2.913;P=0.020).IL-12:IAH-20(236.57± 14.21μg/L)&Cnotrol(192.62±15.69gg/L)(t=-8.989;95%CI:-53.763～-34.139;P=0.000);IAH20-R(228.52±16.16μg/L)&Cnotrol(192.62±15.69μg/L)(t=-7.338;95%CI:-45.720～-26.092;P=0.000);IIAH-10(190.41±12.39μg/L)&IAH-20(236.577±14.21μg/L)(t=-11.168;95%CI:-54.459～-37.849;P=0.000);IAH10-R(188.52±14.75μg/L)&IAH20-R(228.52±16.16μg/L)(t=8.491;95%CI:30.545～49.460;P=0.000).6h after operation blood sample test:TBIL:IAH-20(35.7±2.5μmol/L)&Cnotrol(24.7±1.6μmol/L)(t=-12.133;95%CI:-12.903～-9.221;P=0.000);IAH20-R(32.1±3.4μmol/L)&Cnotrol(24.77±1.6μmol/L)(t=-10.370;95%CI:-8.887～-6.002;P=0.000);IAH-10(25.2±1.7μmol/L)&IAH-20(35.7±2.5μmol/L)(t=-11.377;95%CI:-12.418～-8.668;P=0.000);IAH10-R(25.1±1.5μmol/L)&IAH20-R(32.1±3.4μmol/L)(t=-10.024;95%CI:-8.406～-5.594;P=0.000).ALT:IAH-20(562.2±41.7 IU/L)&Cnotrol(349.5±31.0IU/L)(t=-12.718;95%CI:-246.584～-179.004;P=0.000);IAH20-R(509.0±33.4 IU/L)&Cnotrol(349.5±31.0 IU/L)(t=-15.778;95%CI:-179.877～-139.248;P=0.000);IAH-20(562.2±41.7 IU/L)&IAH20-R(509.0±33.4 IU/L)(t=-2.641;95%CI:10.264-96.204;P=0.019);IAH10-R(359.5±25.4 IU/L)&IAH20-R(509.0±33.4 IU/L)(t=-16.668;95%CI:-167.511～-131.431;P=0.000).AST:IAH-20(2137.66±153.9 IU/L)&Cnotrol(1327.9±117.7IU/L)(t=-12.771;95%CI:-937.725～-681.645,P=0.000);IAH20-R(1933.8±127.0 IU/L)&Cnotrol(1327.9±117.7 IU/L)(t=-15.760;95%CI:-683.076～-528.648;P=0.000);IAH-20(2137.6±153.9 IU/L)&IAH20-R(1933.8±127.0 IU/L)(t=-2.683;95%CI:41.913～365.733;P=0.017);IAH-10(354.4±29.9 IU/L)&IAH-20(2137.6±153.9 IU/L)(t=-12.847;95%CI:-915.187～-666.201;P=0.000);IAH10-R(1366.6±97.0 IU/L)&IAH20-R(1933.8±127.0)(t=-16.614;95%CI:-635.813～-498.466;P=0.000).TNF-α:IAH-20(562.3±41.7ng/L)&Cnotrol(358.2±27.4ng/L)(t=-13.562;95%CI:-234.474～-173.694;P=0.000);IAH20-R(569.0±33.4 ng/L)&Cnotrol(358.2±27.4 ng/L)(t=-16.272;95%CI:-169.471～-132.230;P=0.000);IAH-20(562.3±41.7ng/L)&LAH20-R(569.0±33.4ng/L)(t=-2.641;95%CI:-96.204～-10.264;P=0.019);IAH-10(357.2±29.0ng/L)&IAH-20(562.3±41.7ng/L)(t=-12.900;95%CI:-237.267～-172.948;P=0.000);IAH10-R(359.5±25.4 ng/L)&IAH20-R(569.0±33.4ng/L)(t=-16.668;95%CI:131.431～167.511;P=0.000).IL-1β:There was no difference in all the rats’teams.(P>0.05).IL-2:There was no difference in all the rats’ teams.(P>0.05);IL-10:IAH-20(184.49±30.43μg/L)&Cnotrol(253.09±54.4μg/L)(t=2.464;95%CI:12.366～124.814;P=0.018);IAH20(184.49±30.43μg/L)&IAH20-R(237.86±37.18μg/L)(t=-2.597;95%CI:9.572～97.158;P=0.020);IAH-10(257.03±55.34μg/L)&IAH-20(184.49±30.43μg/L)(t=2.560;95%CI:15.221～129.843;P=0.014).IL-12:IAH-20(635.21±47.31μg/L)&Cnotrol(581.21±46.54μg/L)(t=-2.207;95%CI:-103.408～-4.595;P=0.033);’ IAH-10(575.22±35.89μg/L)&IAH-20(635.21±47.31μg/L)(t=-3.089;95%CI:-99.266～-20.711;P=0.004);IAH10-R(567.69±43.9μg/L)&IAH20-R(601.05±43.77μg/L)(t=2.349;95%CI:4.785～61.937;P=0.023).8h after operation blood sample test:TBIL:IAH-20(72.7±5.4IU/L)&Cnotrol(37.0±2.5 IUIL)(t=-22.014;95%CI:-38.971～-32.417;P=0.000);IAH20-R(62.8±6.8 IU/L)&Cnotrol(37.0±2.5 IU/L)(t=-19.762;95%CI:-28.447～-23.193;P=0.000);IAH-20(72.7±5.4 IU/L)&IAH20-R(62.8±6.8 IU/L)(t=2.292;95%CI:0.486～19.262;P=0.041);IAH-10(37.9±2.4 IU/L)&IAH-20(72.7±5.4 IU/L)(t=-21.727;95%CI:-38.025～-31.538;P=0.000);IAH10-R(37.8±2.5 IU/L)&IAH20-R(62.8±6.8 IU/L)(t=-18.101;95%CI:-27.787～-22.216;P=0.000).ALT:IAH-20(806.5±42.1 IU/L)&Cnotrol(529.6±47.1 IU/L)(t=-9.863;95%CI:-333.595～-220.131;P=0.000);IAH20-R(695.1±46.9 IU/L)&Cnotrol(529.6±47.1 IU/L)(t=-10.305;95%CI:-197.805～-133.216;P=0.000);IAH-10 547.8±46.8 IU/L)&IAH10-R(524.9±32.0IU/L)(t=2.368;95%CI:3.593～42.054;P=0.021);IAH-20(806.5±42.1 IU/L)&IAH20-R(695.1±46.9 IU/L)(t=3.707;95%CI:45.807～176.807;P=0.003);IAH-10(547.8±46.8 IU/L)&IAH-20(806.5±42.1 IU/L)(t=-9.254;95%CI:-315.360～-202.069;P=0.000):IAH10-R(524.9±32.0 IU/L)&IAH20-R(695.1±46.9 IU/L)(t=-13.611;95%CI:-195.401～-144.970;P=0.000).AST:IAH10-R(2100.3±128.5 IU/L)&Cnotrol(2118.8±187.9 IU/L)(t=0.485;95%CI:-57.716～94.798;P=0.029);IAH-20(3238.2±193.0 IU/L)&Cnotrol(2118.8±187.9IU/L)(t=-9.931;95%CI:-1347.171～-891.547;P= 0.000);IAH20-R(2781.6±186.9 IU/L)&Cnotrol(2118.8±187.9 IU/L)(t=10.344;95%CI:-791.586～-533.941;P=0.000);IAH-10(2190.1±186.9 IU/L)&IAH10-R(2100.3±128.5 IU/L)(t=2.331;95%CI:12.923～166.788;P=0.023);IAH-20(3238.2±193.0 IU/L)&IAH20-R(2781.6±186.9 IU/L)(t=3.730;95%CI:189.855～723.335;P=0.003);IAH-10(2190.1±186.9 IU/L)&.IAH-20(3238.2±193.0IU/L)(t=-9.316;95%CI:-1275.991～-820.097;P=0.000);IAH10-R(2100.3±128.5 IU/L)&IAH20-R(2781.6±186.9 IU/L)(t=-13.618;95%CI:-782.199～-580.410;P=0.000).TNF-a:IAH-20(809.8±38.7ng/L)&Control(529.6±47.1 ng/L)(t=-10.013;95%CI:-338.752～233.640;P=0.000);IAH20-R(713.3±39.9 ng/L)&Control(529.6±47.1 ng/L)(t=-11.776;95%CI:-215.055～-152.330;P=0.000);IAH-10(547.8±46.8ng/L)&IAH10-R(524.9±32.0ng/L)(t=2.368;95%CI:3.593～42.054;P=0.021);IAH-20(809.8±38.7ng/L)&IAH20-R(713.3±39.9ng/L)(t=-3.730;95%CI:-152.879～-40.128;P=0.003);IAH-10(547.8±46.8ng/L)&IAH-20(809.8±38.7ng/L)(t=-9.405;95%CI:-318.500～-205.595;P=0.000);IAH10-R(524.9±32.0ng/L)&IAH20-R(713.3±39.9ng/L)(t=15.953;95%CI:164.555～212.180;P=0.000).IL-1β:IAH-20(1109.8±68.1ng/L)&Control(432.8±46.3 ng/L)(t=-23.740;95%CI:-734.620～-619.354;P=0.000);IAH20-R(905.1±50.9 ng/L)&Control(432.8±46.3 ng/L)(t=-29.272;95%CI:-504.743～-439.860;P=0.000);IAH-10(450.0±47.0ng/L)&IAH10-R(426.8±32.0ng/L)(t=2.401;95%CI:3.972～45.535;P=0.019);IAH-20(1109.8±68.1ng/L)&IAH20-R(905.1±50.9ng/L)(t=-5.804;95%CI:-281.522～-127.849;P=0.000);IAH-10(450.0±47.0ng/L)&IAH-20(1109.8±68.1ng/L)(t=-22.677;95%CI:-718.722～-600.821;P=0.000);IAH10-R(426.8±32.0ng/L)&IAH20-R(905.1±50.9ng/L)(t=36.999;95%CI:452.246～504.388;P=0.000).IL-2:IAH-20(127.8±4.9 pg/ml)&Cnotrol(148.4±13.1 pg/ml)(t=2.687;95%CI:5.105～36.109;P=0.010);IAH20-R(132.3±9.5 pg/ml)&Cnotrol(148.4±13.1 pg/ml)(t=3.801;95%CI:7.592～24.644;P=0.000);IAH-10(147.9±10.5 pg/ml)&IAH-20(127.8±4.9 pg/ml)(t=3.255;95%CI:7.582～32.589;P=0.002);IAH10-R(148.2±11.5 pg/ml)&IAH20-R(132.3±9.5 pg/ml)(t=4.125;95%CI:8.111-23.628;P=0.000).IL-10:IAH-20(259.64±46.57 μg/L)&Cnotrol(390.47±85.63μg/L);(t=2.596;95%CI:28.984～232.672;P=0.013);IAH-20(259.64±46.57μg/L)&IAH20-R(386.76±54.81μg/L);(t=3.646;95%CI:51.159～203.072;P=0.003);IAH-10(396.77±88.32μg/L)&IAH20(259.64±46.57μg/L);(t=2.636;95%CI:31.719-242.547;P=0.012).IL-12:IAH-20(1869.41±51.88μg/L)&Cnotrol(1361.66±109.84μg/L);(t=-7.870;95%CI:-638.136～-377.351;P=0.000);IA.H20-R(1547.35±71.93μg/L)&Cnotrol(1361.66±109.84μ/L);(t=-5.276;95%CI:-256.451～114.920;P=0.000);IAH-20(1869.41±51.88μg/L)&IAH20-R(1547.35±71.93μg/L)(t=-7.167;95%CI:-419.966～-224.150;P=0.000);IAH-10(1347.01±85.84μg/L)&IAH-20(1869.41±51.88μg/L);(t=-10.305;95%CI:-625.111～-419.688;P=0.000);IAH10-R(1328.39± 105.34μg/L)&IAH20-R(1547.35±71.93μg/L);(t=6.403;95%CI:149.996～287.924;P=0.000).There were more hepatocellular necrosis(HE staining)and hepatocellular apoptosis(Tunel method)if Intra-abdominal hypertension continued.Hepatocellular apoptosis in Control(99±4 个);Hepatocellular apoptosis in IAH-10(63±42 个);Hepatocellular apoptosis in IAH10-R(35± 15 个);Hepatocellular apoptosis in IAH20(163±27 个);Hepatocellular apoptosis in IAH20-R(64Q25 个).Compared with Control(P<0.05).IAH-10(63±42 个)&IAH-20(163±27 个)(t=-3.883;95%CI:-172.539～-28.661;P=0.018).IAH-20(163±27个)&IAH20-R(64±25 个)(t=5.772;95%CI:51.486～146.914;P=0.004).Conclusion In our animal experiments of hepatic ischemia reperfusion injury accompanied with intra-abdominal hypertension.There were no difference in operation success rate(P>0.05).Intra-abdominal pressure higher then 20mmHg was risk factor of rats’ death.TBIL,ALT,AST rise up just after operation may due to hepatic ischemia reperfusion injury.It could get graver because hepatic ischemia reperfusion injury accompanied with intra-abdominal hypertension.It showed us that intra-abdominal hypertension spoiled hepatic cell at HE staining.Release the intra-abdominal pressure could reverse the damage of hepatic cell.Hepatic ischemia reperfusion injury spoiled hepatic cell structure and function.Intra-abdominal hypertension stumped recover of hepatic cell which suffered ischemia reperfusion injury.TNF-α,IL-1β,IL-2,IL-10,IL-12 rise up after operation.It were difference in each single parameter.There were trend that hepatic ischemia reperfusion injury accompanied with intra-abdominal hypertension would due to excessive inflammatory reaction.Furthermore,intra-abdominal hypertension would due to more hepatocellular necrosis and hepatocellular apoptosis in different rats’ teams.Part 3.The relationship of intra-abdominal hypertension and fluid management during liver transplantation operation timeObjective To study the correlation of fluid management during operation time and intra-abdominal pressure.To research the correlation of intra-abdominal pressure and abdominal ultrasound’s parameter of transplanted liver’s hemodynamics.Method We collected 95 receptors’ data who received liver transplantation then admission into ICU in the First People’s Hospital of Kunming City from September 2008 to September 2014.Data include Child-Pugh score,total operating time,anhepatic phase time,blood lose intraoperative,crystal solution input,colloidal fluid input,red blood cell infusion,plasm infusion,total fluids input intraoperative,fluids input per hour,urinary production per hour.We monitored intra-abdominal pressure and abdominal ultrasound at the seem time.We used the Logistic regression method to found the risk factor of intra-abdominal intra-abdominal hypertension which occurred after operation.We used Correlate method to analysis the relationship between ultrasound hemodynamics data and intra-abdominal pressure.We used SPSS to do all statistic analysis.Mean use ±s.P=0.05.Result 18.94%(18/95)of the patients occurred intra-abdominal hypertension.Fluids input per hour(>2000ml/h)is risk factor(B=1.62;P<0.05;OR=5.07,95%CI:1.41-18.23)of intra-abdominal hypertension.Urinary production per hour(<200ml/h)is risk protect factor(B=-3.21;P<0.01;OR=0.04,95%CI:0.01-0.18)of intra-abdominal hypertension.We find that there were correlation between hepatic artery peak flow velocity and intra-abdominal pressure(r=0.83,P<0.01),between portal vein peak flow velocity and intra-abdominal pressure(r=-0.182,P<0.05),between retrohepatic inferior vena cava peak flow velocity and intra-abdominal pressure(r=-0.184,P<0.05).Conclusion We found that fluids input per hour should be controlled in a low level and urinary production per hour should be improved in order to prevent intra-abdominal hypertension.There are correlation between hepatic artery peak flow velocity and intra-abdominal pressure,between portal vein peak flow velocity and intra-abdominal pressure,between retrohepatic inferior vena cava peak flow velocity and intra-abdominal pressure.Part 4.Treated an Abdominal Compartment Syndrome Patient by Bedside Decompressive LaparotomyObjective To observe the effect in treating an abdominal compartment syndrome patient by bedside decompressive laparotomy.Method We observed a patient suffered intra-abdominal hypertension and abdominal compartment syndrome after liver transplantation was performed.The patient’s life and graft were threatened by IAH/ACS.Bedside decompressive laparotomy was performed.The patient’s intra-abdominal pressure,invasive artery blood pressure,mean arterial pressure,abdominal perfusion pressure,respiratory rate,heart rate,oxygen saturation,dose of vasoactive drugs,C-reactive protein,albumin,total bilirubin,direct bilirubin,indirect bilirubin,alanine aminotransferase,aspartate aminotransferase,glutamyl transpeptidase,creatinine,brain natriuretic peptide,urine output per hour were observed.Result The patient’s intra-abdominal pressure rose up quickly.His condition got worse then his admitted in ICU.Bedside decompressive laparotomy was performed at 8 hours after liver transplantation.After then,the patient’s intra-abdominal pressure decreased.The patient’s blood pressure,respiratory rate,heart rate,oxygen saturation got better than before.Dose of vasoactive drugs,C-reactive protein,albumin,total bilirubin,direct bilirubin,indirect bilirubin,alanine aminotransferase,aspartate aminotransferase,glutamyl transpeptidase,creatinine decreased.Brain natriuretic peptide,urine output per hour rose up.Conclusion Patient will suffer IAH/ACS because IAP rises up quickly.Bedside decompressive laparotomy can solve IAH/ACS.Part 5.Relationship between Fluid Management Factors and Intra-abdominal Hypertension after Postpartum HemorrhageObjective Prospective observation in specific ratio and risk factors of Intra-abdominal hypertension after postpartum hemorrhage.To find effective treatment protocols to IAH.Method 64 patients’ who were received by Intensive Care Unit from January 2013 to January 2015 clinical data were collected.Data include age,whether or not preeclampsia,hysterectomy,transcatheter arterial embolization condition,crystal solution input in 12 hours,colloid solution input in 12 hours,blood infusion in 12 hours,total fluids input in 12 hours,total fluids output in 12 hours,fluids input per hour,urinary production per hour.We used the Logistic regression method to found the risk factors of intra-abdominal hypertension which occurred after received by ICU.The first 24 hours after patients were received by ICU.We gave diuresis or dialysis method to ensure the patients output>input exceed 1000ml.We compared intra-abdominal pressure,ALT,AST,ALB,TBIL,BUN,CRE,length of stay in ICU,length of stay in hospital between patients who occurred IAH or not.We compared intra-abdominal pressure,ALT,AST,ALB,TBIL,BUN,CRE which gained from patient when they were received by ICU and 24 hours after.We used SPSS to do all statistical analysis.Mean use ±s.P=0.05.Quantity data analyzed by t test.Qualitation data analyzed by chi square test.Result 23.4%(15/64)patients occurred IAH.preeclampsia(B=1.67,P=0.03,OR=5.30,95%CI 1.15～24.45),fluids input per hour>1000ml(B=1.68,P=0.03,OR=5.34,95%CI 1.14～24.92),urinary production per hour<200ml(B=-1.76,P=0.00,OR=0.17,95%CI 0.05-0.58)are risk factors of IAH.The level of IAP,ALT,AST,TBIL,BUN,CRE were higher in the group of IAH than no IAH group(P<0.05).Length of stay in ICU,length of stay in hospital were longer in the group of IAH than no IAH group(P<0.05).After we gave dieresis or dialysis method to ensure the patients output>input exceed 1000ml.24 hours later after all patients entered ICU.IAP,TBIL,BUN,CRE level fall down(P<0.05).ALB level rose up(P<0.05).Conclusion We found that fluids input per hour should be controlled in a low level and urinary production per hour should be improved in order to prevent intra-abdominal hypertension during the time of rescue in postpartum hemorrhage patients.Preeclampsia is one of the risk factor lead to IAH.IAH may harm to patients’liver function and kidney function.