氨在肝性脑病发病机制中的作用 (2).ppt

氨在肝性脑病发病机制中的作用,知识回顾,概念 临床表现 氨中毒学说,一、目的 二、药品器材动物 三、方法步骤 四、结果 五、讨论分析 六、结论,操作步骤,固定、局麻 上腹部正中切口，开腹 剪镰状韧带 辩明肝叶、肝叶结扎 12指肠荷包缝合并插管 腹壁全层连续缝合，关腹腔 观察 输液（60滴/分） 动物大抽搐时，记录时间用量 动物死亡时，记录时间用量,局麻,镰状韧带,肝脏各叶,结扎肝叶,荷包缝合,十二指肠插管,腹壁全层连续缝合,大抽搐,脚弓反张,肌肉强直,实验分组如下： 甲组：肝叶结扎+滴注氯化铵 乙组：肝叶不结扎+滴注氯化铵 丙组：肝叶结扎+滴注氯化钠 丁组：肝叶结扎+耳缘推注谷氨酸钠溶液20ml/kg+滴注氯化铵,结果,注意比较丙组与甲组；甲组与乙组；丁组与甲组,注意事项,剪镰状韧带时勿伤及膈肌和血管 肝叶扎紧 12指肠插管的方向 各组液体滴速尽量保持一致(60滴/分),NH4+,NH3,H+,OH-,Liver Krebs-Heneseleit,urea,BBB,Brain,1.Impairment of energy metabolism 2.Alteration of neurotransmitters,function Impaired,Portosystemic shunting,NH3 ,What reasons cause the blood ammonia elevated?,ornithine,citrulline,arginine,arginase,urea,Krebs-Heneseleit urea cycle There would be produced 1 urea molecule and use up 3 NH3 molecules every one circle.,pH=7.4, 99% 1% NH37.45, NH3 ,Easy to be absorbed, and pass through into BBB Have toxic effect on brain cell,Difficulty to be absorbed,and go across into BBB Have no toxic effect on brain cell,Which is the toxic to brain cell?,NH4+,NH3,H+,OH-,Glutamine,BBB,Brain,+MSG,NH3,Glutamine, a kind of biogenic amine, cant pass through BBB, only in peripheral blood, rather than cerebrospinal fluid.,结论,