氨在肝性腦病發(fā)病機(jī)制中的作用

1、氨在肝性腦病發(fā)病機(jī)制中的作用1知識(shí)回顧概念臨床表現(xiàn)氨中毒學(xué)說(shuō)2一、目的二、藥品器材動(dòng)物三、方法步驟四、結(jié)果五、討論分析六、結(jié)論3操作步驟固定、局麻上腹部正中切口，開腹剪鐮狀韌帶辯明肝葉、肝葉結(jié)扎12指腸荷包縫合并插管腹壁全層連續(xù)縫合，關(guān)腹腔觀察輸液（60滴/分）動(dòng)物大抽搐時(shí)，記錄時(shí)間用量動(dòng)物死亡時(shí)，記錄時(shí)間用量4局麻鐮狀韌帶肝臟各葉結(jié)扎肝葉5荷包縫合十二指腸插管腹壁全層連續(xù)縫合大抽搐,腳弓反張,肌肉強(qiáng)直6實(shí)驗(yàn)分組如下：甲組：肝葉結(jié)扎+滴注氯化銨乙組：肝葉不結(jié)扎+滴注氯化銨丙組：肝葉結(jié)扎+滴注氯化鈉丁組：肝葉結(jié)扎+耳緣推注谷氨酸鈉溶液20ml/kg+滴注氯化銨7結(jié)果 抽搐 死亡 時(shí)間 用量（ml

2、/kg） 時(shí)間 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 注意比較丙組與甲組；甲組與乙組；丁組與甲組8注意事項(xiàng)剪鐮狀韌帶時(shí)勿傷及膈肌和血管肝葉扎緊12指腸插管的方向各組液體滴速盡量保持一致(60滴/分)9 NH4+ NH3H+OH-LiverKrebs-HeneseleitureaBBBBrain1.Impairment of energy metabolism 2.Alteration of neurotransmittersfunction ImpairedPortosystemic sh

3、unting 10NH3 production (from small intestine)clearance (liver insufficiency/dysfunction)What reasons cause the blood ammonia elevated? 11ornithinecitrullinearginine arginase ureaKrebs-Heneseleit urea cycleThere would be produced 1 urea molecule and use up 3 NH3 molecules every one circle.12pH=7.4,

4、99% 1% NH37.45, NH3 H+OH- NH4+ NH3Easy to be absorbed, and pass through into BBBHave toxic effect on brain cellDifficulty to be absorbed,and go across into BBBHave no toxic effect on brain cellWhich is the toxic to brain cell? 13 NH4+ NH3H+OH-GlutamineBBBBrain+MSG NH3Glutamine, a kind of biogenic amine, cant pass through BBB,