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,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,氨在肝性脑病发病机制中的作用,氨在肝性脑病发病机制中的作用,1,知识回顾,概念,临床表现,氨中毒学说,知识回顾概念,2,一、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,一、目的,3,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,操作步骤固定、局麻,4,局麻,镰状韧带,肝脏各叶,结扎肝叶,局麻镰状韧带肝脏各叶结扎肝叶,5,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,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,6,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,实验分组如下：,7,结果,抽搐 死亡,时间 用量（ml/kg）时间 用量（ml/kg）,甲 12 25.6 24 46.6,乙 22 35.7 35 40.7,丙,丁 16/18 29.4/26.8 25 52.9,注意比较丙组与甲组；甲组与乙组；丁组与甲组,结果 抽搐,8,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),注意事项剪镰状韧带时勿伤及膈肌和血管,9,NH,4,+,NH,3,H,+,OH,-,Liver,Krebs-Heneseleit,urea,BBB,Brain,1.Impairment of energy metabolism,2.Alteration of neurotransmitters,function Impaired,Portosystemic shunting,NH4+NH3H+OH-LiverureaBBBBra,10,NH,3,production,(from small intestine),clearance,(liver insufficiency/dysfunction),What reasons cause the blood ammonia elevated?,NH3 production clearance,11,ornithine,citrulline,arginine,arginase,urea,Krebs-Heneseleit urea cycle,There would be produced 1 urea molecule and use up 3 NH,3,molecules every one circle.,ornithinecitrullinearginine ar,12,pH=7.4,99%1%NH,3,7.45,NH,3,H,+,OH,-,NH,4,+,NH,3,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?,pH=7.4,99%,13,NH,4,+,NH,3,H,+,OH,-,Glutamine,BBB,Brain,+,MSG,NH,3,Glutamine,a kind of biogenic amine,cant pass through BBB,only in peripheral blood,rather than cerebrospinal fluid.,NH4+NH3H+OH-GlutamineBBBBra,14,结论,结论,15,
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