国际麻醉学与复苏杂志   2012, Issue (5): 4-4
    
不同剂量盐酸戊乙奎醚对创伤性休克兔肠粘膜损伤的保护作用
许铁, 梁鹏冲1()
1.徐州医学院麻醉学院
The Protective Effects of Penehyclidine Hydrochloride in Different Dosages on Intestinal Mucosa Injury in Rabbits with Traumatic Shock Model
 全文:
摘要:

【摘要】 目的 研究不同剂量盐酸戊乙奎醚(Penehyclidine Hydrochloride,PHC)对创伤性休克兔肠粘膜损伤的保护作用。方法 采用Lamson′s法建立创伤性休克动物模型,30只健康日本长耳大白兔,随机分为对照组(Con组),0.9%氯化钠溶液复苏组(NS组),低剂量(0.05mg/kg)、中剂量(0.15mg/kg)和高剂量(0.45mg/kg)PHC复苏组(PHCL组、PHCM组和PHCH组)。分别在休克前(T1),休克末(T2),复苏后即刻(T3)、2h(T4)、4h(T5)和6h(T6)等6个时间点监测平均动脉压(MAP)和心率(HR)并采血检测二胺氧化酶(Diamine oxidase, DAO)活性和D-乳酸浓度。实验结束后放血处死动物取小肠组织,光镜下检查病理学变化。结果 各实验组动物T2点的MAP显著降低(均≤45mmHg); T3~6点NS组的MAP分别是68.8±3.0、67.5±5.3、71.0±3.7和71.0±2.4mmHg,显著低于休克前(94.3±1.7mmHg)、Con组(82.8±4.1、89.8±6.6、82.4±3.3和94.4±6.2mmHg)和PHCM组(83.2±13.6、82.2±9.0、83.8±8.9和85.4±8.1mmHg),差异有统计学意义(P<0.05或P<0.01)。T3~6点N S组的HR(185±11、181±7、164±13和164±13次/min)较休克前(276±13次/min)显著降低,与Con组和PHCM组相比差异有统计学意义(P<0.05或P<0.01)。T2~6点各实验组动物的血浆DAO活性和D-乳酸浓度较休克前显著升高;T3~6点NS组的血浆DAO活性(0.393±0.020、 0.586±0.017、0.844±0.036和0.568±0.016 u/ml)和D-乳酸浓度(8.292±0.364、7.539±0.098、5.991±0.180和7.108±0.372 mmol/L)显著高于PHCL组和PHCH组,后两组又显著高于PHCM组(0.111±0.016, 0.302±0.020, 0.501±0.014 和0.183±0.018 u/ml,5.664±0.546, 4.609±0.292, 3.310±0.363 and 4.720±0.205 mmol/L),差异有统计学意义(P<0.05或P<0.01)。病理组织学检查显示PHCM的组肠粘膜损伤程度轻于其他试验组。结论 PHC联合0.9%氯化钠溶液复苏能稳定创伤性休克兔的血流动力学;对创伤性休克造成的肠粘膜损伤有确切的保护作用,中剂量的PHC保护效果更为显著;血浆DAO活性、D-乳酸浓度可以评估肠粘膜损伤及屏障功能情况。

关键词: 【关键词】创伤性休克;盐酸戊乙奎醚;血浆二胺氧化酶;D-乳酸;平均动脉压
Abstract:

【Abstract】 To investigate the protective effects of penehyclidine hydrochloride in different dosages on intestinal mucosa injury in rabbits with traumatic shock. Methods: The animal model of traumatic shock was established by Lamson's method. Thirty rabbits was randomly divided into five groups: control group(Con group), traumatic shock group resuscitation with normal saline (NS group), traumatic shock group resuscitation with penehyclidine hydrochloride in low dosages(0.05mg/kg, PHCL group),middle dosages(0.15mg/kg, PHCM group) and high dosages(0.45mg/kg, PHCH group). At pre-shock, tele-shock, four time points after resuscitation, mean arterial pressure(MAP) and heart rate(HR) were monitored, plasma diamine oxidase(DAO) activity and lactic acid concentration were measured by spectrophotometry. The pathological changes of tissue samples of the intestine were observed under microscope. Results: There were no significant differences of MAP at pre-shock between five groups. At tele-shock, the MAP of rabbits in NS group, PHCL group, PHCM group, PHCH group significantly decreased, but there were no significant differences of MAP between groups. At T3~T6 time points, the MAP of rabbits in NS group(68.8±3.0, 67.5±5.3, 71.0±3.7 and71.0±2.4mmHg) was significantly lower than at pre-shock (94.3±1.7mmHg), in Con group(82.8±4.1, 89.8±6.6, 82.4±3.3 and 94.4±6.2mmHg) and PHCM group (83.2±13.6, 82.2±9.0, 83.8±8.9 and 85.4±8.1mmHg). There were no significant differences in HR at pre-shock and tele-shock between five groups. At T3~T6 time points, the HR of rabbits in NS group(185±11, 181±7, 164±13 and 164±13 bpm) were significantly lower than at T1(276±13 bpm), also significantly (P<0.05 or P<0.01) lower than in Con group and PHCM group. The plasma DAO activity and D-lactate concentration in NS group, PHCL group, PHCM group, PHCH group were significantly increased at T2~T6 time points. Furthermore, at T3~T6 time points, the plasma DAO activity (0.393±0.020, 0.586±0.017, 0.844±0.036 and 0.568±0.016 u/ml) and D-lactate concentration (8.292±0.364, 7.539±0.098, 5.991±0.180 and 7.108±0.372 mmol/L) in NS group were significantly higher than in PHCL group and PHCH group, that in PHCL group and PHCH group were significantly higher than in PHCM group(0.111±0.016, 0.302±0.020, 0.501±0.014 and 0.183±0.018 u/ml, 5.664±0.546, 4.609±0.292, 3.310±0.363 and 4.720±0.205 mmol/L) (P<0.05 or P<0.01). The result of pathology showed that intestinal mucosal injury of rabbits in PHCM groups was significantly reduced compared with NS group. Conclusions: The resuscitation of PHC combinition with normal saline can stabilize hemodynamics in rabbits with traumatic shock. There was a significant protective effect on intestinal mucosal injury induced by traumatic shock, especially in PHCM. The plasma DAO activity and D-lactate concentration can be uesed to assess the extent of intestinal mucosa injury and barrier function.

Key words: 【Key words】traumatic shock, penehyclidine hydrochloride, plasma diamine oxidase, D-lactate, mean arterical blood pressure.