Fatih YÖRÜK, Şükran GEZE, Mustafa TUSAT, Ahmet MENTEŞE, Esin YULUĞ, Emre BEYAZTAŞ, Ahmet ALVER

Deneysel laparoskopi modelinde pnömoperitonyuma bağlı akciğer hasarını önlemede magnezyumun etkisi

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

Anahtar Kelimeler:

Pnömoperitonyum, akciğer hasarı, magnezyum

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

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

Keywords:

Pneumoperitoneum, lung injury, magnesium,

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