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1、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
2、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-,LiverKrebs-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,citrullin
3、e,arginine,arginase,urea,Krebs-Heneseleit urea cycleThere 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 BBBHave toxic effect on brain cell,Difficulty to be absorbed,and go across into BBBHave 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,
