国际麻醉学与复苏杂志   2015, Issue (11): 0-0
    
七氟烷对失血性休克巴马小型猪肠屏障功能的影响
王丽晶, 王丽斯, 孙莹杰, 刁玉刚, 陈克研, 宋丹丹1()
1.沈阳军区总医院
The effects of Sevoflurane on pigs’ gut barrier injury in hemorrhagic shock
 全文:
摘要:

【摘要】目的:通过观察七氟烷对失血性休克巴马小型猪肠屏障功能的影响,以探讨七氟烷对其的保护作用。 方法:24头巴马小型猪随机分为对照组(S组)、失血性休克组(HS组)、七氟烷预处理组(Pre/Sev组)及七氟烷后处理组(Post/Sev组),每组6头。实验动物术前禁食8h,给予丙泊酚3mg/kg实施麻醉。S组麻醉后经股动脉和颈内静脉置管;HS组麻醉置管后建立失血性休克模型;Pre/Sev组麻醉置管后给予2%七氟烷吸入30min后建立失血性休克模型;Post/Sev组于麻醉置管建立失血性休克模型成功后给予2%七氟烷吸入30min。各实验组均于麻醉前(T0)、失血性休克后30min(T1)、1h(T2)、1.5h(T3)、2h(T4)、3h(T5)、4h(T6)时间点于颈内静脉采取外周血,ELISA法检测血清肿瘤坏死因子(TNF-a)、白介素6(IL-6)、D-乳酸、肠脂肪酸结合蛋白(I-FABP)的含量。失血性休克4h后放血处死实验动物取肠组织制作病理切片,HE染色观察各组病理组织学变化;并取下腔静脉血、肠系膜淋巴结(MLN)、肝、肺、肾、脾组织进行细菌培养,计算远隔器官移位率。结果:与S组相比,HS组、Pre/Sev组和Post/Sev组血清D-乳酸、I-FABP、IL-6、TNF-a含量和远隔脏器细菌移位率均显著升高,差异有统计学意义(P<0.05)。与HS组相比较,Pre/Sev组和Post/Sev组上述指标均显著降低,差异有统计学意义(P<0.05)。Pre/Sev组和Post/Sev组比较,上述指标差异无统计学意义(P>0.05)。光镜显示,S组肠黏膜未见明显变化;HS组肠黏膜损伤严重,可见肠粘膜出血,炎细胞浸润,上皮细胞坏死; Pre/Sev组和Post/Sev组损伤明显减轻,仅见粘膜层腺体轻度扩张,上皮层和固有层中度分离,上皮下间隙轻度水肿,少许炎细胞浸润。结论:本研究结果提示七氟烷可减轻失血性休克引起的肠黏膜屏障损伤,其保护机制可能与抑制炎性反应有关。

关键词: 肠屏障;失血性休克;七氟烷
Abstract:

【Abstract】Objective: To observe the influences of sevoflurane on pig’s intestinal barrier function in hemorrhagic shock. Methods: Bama miniature pigs (24) were randomly divided into four equal groups (n=6 wells each)using a random number table: sham group (group S), hemorrhagic shock group (group HS), sevoflurane preconditioning group (group Pre /Sev) and sevoflurane post-treatment group (group Post / Sev).Experimental animals were fasted for 8 hours before surgery, intravenous propofol 3mg/Kg from the ear vein, endotrachealing intubation when animal sleep. In group S, only the position of the femoral artery and the jugular vein catheter after anesthesia, vital signs to detect. We built a hemorrhagic shock model in group HS through the femoral artery bleeding after anesthesia and catheterization. In group Pre/Sev, builtting hemorrhagic shock model after preconditioning 2% sevoflurane 30min . In Post / Sev group post –conditioning 2% sevoflurane 30min after a successful hemorrhagic model. Blood samples were collected at prior to anesthesia (T0), after hemorrhagic shock 30min (T1), 1h (T2), 1.5h (T3), 2h (T4 ), 3h (T5), 4h (T6) 7 time points, ELISA was used to detect the change of content of IL-6, TNF-a ,D-lactic acid and I-FABP in Serum. Experimental animals in each group were observed and sacrificed after shock 4h. Histopathological changes in the intestinal tissue was observed by HE staining; Vena cava blood and tissue samples were used to monitor bacterial growth. Results: Compared with group S, the serum TNF-a , IL-6, I-FABP, D-Lac contentions and bacterial translocation rate were significantly increased in group HS, Pre/Sev and Post/Sev (P<0.05). Compared with group HS, the above indices were significantly reduced in group Pre/Sev and Post/Sev (P<0.05). There was no significant difference in the above indices at each time point between group Pre/Sev and group Post/Sev (P > 0.05). These results were confirmed by HE staining. Conclusion: sevoflurane could improve, to some extent, pig’s intestinal barrier function in hemorrhagic shock and this effect is likely related to inhibition of the HS-induced inflammatory response.

Key words: Intestinal barrier; Hemorrhagic shock; Sevoflurane