本文選題：經(jīng)直腸亞低溫 + 缺血缺氧性腦損傷��； 參考：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的觀察新型經(jīng)直腸亞低溫治療對(duì)缺血缺氧性腦損傷SD大鼠腸道細(xì)菌移位的影響,以評(píng)估其安全性,為新型經(jīng)直腸亞低溫治療的臨床應(yīng)用提供實(shí)驗(yàn)依據(jù)。方法本實(shí)驗(yàn)選用30只健康成年SD雄性大鼠,隨機(jī)分成三組：假手術(shù)組(C,n=6)、常溫缺血缺氧組(OT,n=12)、經(jīng)直腸亞低溫缺血缺氧組(MH, n=12)。 OT組和MH組均建立缺血缺氧性腦損傷模型,MH組經(jīng)肛門插入密閉式儲(chǔ)水囊,通過(guò)雙腔密閉式儲(chǔ)水囊持續(xù)灌注等滲冰鹽水,進(jìn)行經(jīng)直腸亞低溫治療,12h后回籠自然復(fù)溫。三組均于缺血缺氧后Oh、12h、24h取血檢測(cè)二胺氧化酶(DAO)、D-乳酸濃度,24h開腹取肝、脾、腸系膜淋巴結(jié)進(jìn)行細(xì)菌培養(yǎng),取直腸組織行HE染色。結(jié)果1.腸粘膜形態(tài)學(xué)變化：C組直腸結(jié)構(gòu)完整。OT組腸上皮脫落壞死,部分粘膜結(jié)構(gòu)消失,上皮細(xì)胞排列紊亂,粘膜下層大量炎性細(xì)胞浸潤(rùn)。MH組直腸組織結(jié)構(gòu)完整,粘膜下層少量炎性浸潤(rùn)表現(xiàn)。2.細(xì)菌培養(yǎng)：實(shí)驗(yàn)結(jié)果顯示,三組均發(fā)現(xiàn)細(xì)菌移位,組間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。C組和MH組只在腸系膜淋巴結(jié)培養(yǎng)出細(xì)菌,且細(xì)菌培養(yǎng)鑒定結(jié)果全部為大腸桿菌。OT組細(xì)菌移位部位主要為腸系膜淋巴結(jié),其次為肝臟、脾臟,與MH組比較無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。OT組細(xì)菌移位部位與細(xì)菌移位路徑一致,提示未經(jīng)過(guò)亞低溫干預(yù)的HIBD大鼠細(xì)菌移位路徑更遠(yuǎn)。OT培養(yǎng)出的細(xì)菌主要為大腸桿菌、嗜麥芽窄食單胞菌、洛菲不動(dòng)桿菌。MH組與C組細(xì)菌移位率相比,沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05)。3.血液DAO、D-乳酸濃度變化：MH組12h血DAO、D-乳酸濃度變化均較Oh顯著降低(P0.05)。結(jié)論1.新型經(jīng)直腸亞低溫治療能維持直腸組織學(xué)的完整性,對(duì)直腸無(wú)損傷。采用雙腔密閉式儲(chǔ)水囊,冰水不直接接觸直腸粘膜,可避免水中毒并發(fā)癥的發(fā)生。2.新型經(jīng)直腸亞低溫治療不會(huì)加重HIBD大鼠的細(xì)菌移位,能維護(hù)腸道微生態(tài)平衡。3.新型經(jīng)直腸亞低溫治療對(duì)HIBD大鼠腸道屏障有良好的保護(hù)作用,對(duì)腸粘膜通透性有降低作用。4.前期及本次動(dòng)物實(shí)驗(yàn)結(jié)果表明,新型經(jīng)直腸亞低溫治療安全可靠,具有便攜、價(jià)廉、簡(jiǎn)便、無(wú)創(chuàng)、安全的優(yōu)點(diǎn)。下一步將進(jìn)行臨床試驗(yàn)以驗(yàn)證其臨床應(yīng)用的安全性。
[Abstract]:Objective to observe the effect of new transrectal mild hypothermia therapy on intestinal bacterial translocation in SD rats with ischemic and hypoxic brain injury in order to evaluate its safety and provide experimental evidence for clinical application of new transrectal mild hypothermia therapy.Methods Thirty healthy adult SD male rats were randomly divided into three groups: sham operation group (n = 6), normothermic ischemia and hypoxia group (n = 12), transrectal hypothermia ischemia / hypoxia group (n = 12) and transrectal hypothermia ischemia / hypoxia group (n = 12).The model of ischemic hypoxic brain injury was established in the OT group and MH group. In the MH group, the closed water storage sac was inserted into the anus, and the cryogenic saline was continuously infused through the double-chamber closed water storage capsule. After 12 hours of transrectal mild hypothermia treatment, natural rewarming was achieved.The blood samples of all the three groups were collected at 12h after ischemia and hypoxia to detect the concentration of diamine oxidase (DAOX) D-lactic acid. The liver, spleen and mesenteric lymph nodes were collected for bacterial culture at 24 h after operation. The rectal tissues were stained with HE.Result 1.Intestinal mucosal morphology changes. The rectum structure of group C was intact. In group OT, the intestinal epithelium was exfoliated and necrotic, some of the mucosal structure disappeared, the epithelial cells were arranged in disorder, and a large number of inflammatory cells were infiltrated in the submucous layer.Submucous submucosa small amount of inflammatory infiltration. 2.Bacterial culture: the results showed that bacterial translocation was found in all three groups. There was no statistical difference between the three groups. Group C and MH only cultured bacteria in mesenteric lymph nodes.The bacterial translocation in E. coli. OT group was mainly mesenteric lymph node, followed by liver and spleen. There was no significant difference between MH group and MH group.The results indicated that the bacterial translocation pathway of HIBD rats without mild hypothermia intervention was more distant. OT culture bacteria were mainly Escherichia coli, Stenotrophomonas maltophilia, and there was no significant difference in bacterial translocation rate between Acinetobacter alopicum group and C group (P 0.05. 3).Changes of DAOD- lactate concentration in blood in the w / MH group for 12 h, the changes of DAOD- lactic acid concentration were significantly lower than that of Oh in the control group (P 0.05).Conclusion 1.New transrectal mild hypothermia therapy can maintain the integrity of rectum histology and no injury to rectum.Double-chamber closed water storage sac, ice water does not directly contact the rectal mucosa, can avoid water poisoning complications. 2. 2.The new transrectal mild hypothermia therapy does not aggravate bacterial translocation in HIBD rats and can maintain intestinal microecological balance. 3.The new transrectal mild hypothermia therapy has a good protective effect on intestinal barrier in HIBD rats and a decrease of intestinal mucosal permeability.The results of previous and animal experiments show that the new transrectal hypothermia therapy is safe, reliable, portable, inexpensive, simple, non-invasive and safe.Next, clinical trials will be conducted to verify the safety of its clinical applications.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R45

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