本文選題：硬膜外阻滯 + 急性胰腺炎�。� 參考：《福建醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的本研究通過建立大鼠急性胰腺炎重型化模型并用硬膜外阻滯對模型水腫階段進(jìn)行干預(yù)，觀察大鼠腫瘤壞死因子-α（tumor necrosis factor alpha，TNF-α）、白介素-6（interleukin-6，IL-6）、血清淀粉酶（AMY）的變化及腺泡細(xì)胞凋亡情況，探討胸段硬膜外阻滯對急性胰腺炎進(jìn)行干預(yù)后的影響。 方法清潔級SD雄性大鼠隨機(jī)分為四組：正常對照組（C組，n=8）、急性胰腺炎組(AP組，n=16)、硬膜外生理鹽水治療組(NS組，n=16)、硬膜外羅哌卡因治療組(TEA組，n=16)。其中AP組、NS組、TEA組又隨機(jī)分為12、24h兩個(gè)時(shí)點(diǎn)（12h，n=8；24h，n=8），腹腔內(nèi)注射8%L-精氨酸溶液（3×150mg/100g大鼠體重bm），每次注射間隔1小時(shí)建立大鼠急性胰腺炎模型。C組同法腹腔注射等量的生理鹽水。建模后12h對三組24h點(diǎn)大鼠做如下處理：TEA組硬膜外每兩個(gè)小時(shí)輸注一次0.1%羅哌卡因（0.01ml／100g bm），NS組同法輸注生理鹽水（0.01ml／100g bm），AP組不做處理。每組大鼠均于造模前(T0)、造模后12小時(shí)(T1)、造模后24小時(shí)(T2)采集血液標(biāo)本，并于T1時(shí)處死12時(shí)相點(diǎn)大鼠、T2時(shí)處死其余大鼠并觀察腹腔情況。采用全自動(dòng)生化分析儀檢測血清淀粉酶（AMY）水平； ELISA法檢測血清TNF-α和IL-6含量；胰腺組織HE染色后光學(xué)顯微鏡觀察并行病理學(xué)評分；TUNEL法檢測24h時(shí)相點(diǎn)大鼠胰腺組織中腺泡細(xì)胞的凋亡情況。 結(jié)果⑴血清生化指標(biāo)：①與C組相比，各處理組血清AMY、TNF-α和IL-6水平顯著升高（P0.01）②與AP組和NS組比較，T2時(shí)TEA組血清TNF-α、 IL-6水平顯著降低（P0.05），T1時(shí)無顯著差異（P＞0.05）；③T2與T1時(shí)比較， TEA組血清AMY、TNF-α和IL-6水平無顯著差異（P＞0.05），AP組和NS組顯著升高（P0.05）；T1與T0時(shí)比較，三組都明顯升高（P0.01）；C組在各時(shí)間點(diǎn)無明顯變化（P＞0.05）。⑵病理學(xué)觀察：①T1時(shí)AP組、NS組、TEA組胰腺組織主要表現(xiàn)為間質(zhì)水腫，腺泡腫脹，炎癥細(xì)胞浸潤。T2時(shí)AP組、NS組可見大片出血壞死和腺泡小葉結(jié)構(gòu)破壞，周圍有大量炎癥細(xì)胞浸潤；TEA組細(xì)胞壞死明顯減輕，炎癥細(xì)胞少②與C組比較，各處理組病理評分顯著升高（P0.01）；與AP組、NS組比較，T2時(shí)TEA組病理評分顯著降低（P0.05）。胰腺組織病理評分與TNF-α和IL-6濃度呈正相關(guān)（r=0.89，r=0.77，P0.01）⑶腺泡細(xì)胞凋亡：C組很少或未觀察到，AP組、NS組觀察到少量的凋亡細(xì)胞, TEA組有大量的凋亡細(xì)胞 結(jié)論①腹腔內(nèi)注射8%L-精氨酸溶液（3×150mg/100g），每次注射間隔1小時(shí)能構(gòu)建大鼠急性胰腺炎重型化模型。②炎性因子及腺泡細(xì)胞凋亡在AP的病程中發(fā)揮重要作用。③硬膜外阻滯能夠預(yù)防AP的重型化，其可能機(jī)制有：能阻斷傷害性刺激的傳入，降低應(yīng)激反應(yīng)，抑制炎性介質(zhì)的釋放，從而誘導(dǎo)腺泡細(xì)胞凋亡，改善胰腺的轉(zhuǎn)歸。
[Abstract]:Objective to observe the changes of TNF- 偽, interleukin-6 (IL-6) and serum amylase (amylase) and acinar cell apoptosis in necrosis factor alpha-TNF- 偽, interleukin-6 (IL-6) and serum amylase (amylase) in rats with severe acute pancreatitis (AP) and intervention with epidural block on the edema stage of the model in this study, and to observe the changes of TNF- 偽, interleukin-6, amylase in serum and apoptosis of acinar cells in rats. To investigate the effect of thoracic epidural block on acute pancreatitis. Methods male SD rats of clean grade were randomly divided into four groups: control group (n = 8), acute pancreatitis group (n = 16), NS group (n = 16), epidural ropivacaine group (n = 16), tea group (n = 16). Among them, the AP group and the NS group were randomly divided into two groups: 12h, 12h, 12h, 12h, 8h, 24h, and 8L arginine solution was injected intraperitoneally into the body weight of 3 脳 150mg/100g rats. The model of acute pancreatitis in group C was established by intraperitoneal injection of the same amount of normal saline at the interval of 1 hour each time. 12 h after modeling, three groups of rats at 24 h were treated as follows: 0.1% ropivacaine 0.01ml / 100g bmMN was infused once every two hours in the control group. The NS group received 0.01ml / 100g saline and 0.01ml / 100g BP respectively. Blood samples were collected at 12 hours after modeling and 24 hours after modeling. The other rats were killed at 12:00 at T 2 and observed the abdominal cavity. The levels of serum amylase (AMY), the levels of TNF- 偽 and IL-6 in serum were detected by Elisa, and the pathological scores were observed by optical microscope after HE staining. Apoptosis of acinar cells in pancreatic tissue of rats at 24 h was detected by Tunel method. Results (1) compared with group C, the serum levels of AMYTNF- 偽 and IL-6 in each treatment group were significantly higher than those in AP group and NS group. There was no significant difference in serum TNF- 偽 and IL-6 levels in tea group when compared with AP group and NS group (P > 0.05). 3There was no significant difference between T 2 and T 1 in the serum levels of AMYN TNF- 偽 and IL-6 in tea group (P > 0.05). The levels of TNF- 偽 and IL-6 in T _ 2 group were significantly higher than those in T _ 1 group (P > 0.05), and the levels of P _ (0.01) in all three groups were significantly higher than those in T _ (0) group. There was no significant change at each time point in group C (P > 0.05). The pathological observation showed that the pancreatic tissue of AP group was mainly characterized by interstitial edema and acinar swelling at 1: 1 T1, and the pancreatic tissue of group C was mainly characterized by interstitial edema and acinar swelling. Large hemorrhage necrosis and acinar lobule structure destruction were observed in AP group and NS group when inflammatory cells were infiltrated at T 2. The necrosis in tea group was obviously alleviated by a large number of inflammatory cells infiltrating in the surrounding group, and there were 2 fewer inflammatory cells in group A than in group C. The pathological score of each treatment group was significantly higher than that of AP group, and the pathological score of tea group was significantly lower than that of AP group. Pancreatic histopathological score was positively correlated with TNF- 偽 and IL-6 concentrations. There were few or no apoptotic cells in acinar cells in group C: C, and a large number of apoptotic cells were observed in tea group. Intracavitary injection of L- arginine solution 3 脳 150 mg / 100 g / 100 g / L injection at an interval of 1 hour per injection could construct a rat model of acute pancreatitis with severe pancreatitis. 2 inflammatory factors and apoptosis of acinar cells played an important role in the course of AP. 3. 3 epidural block could prevent the severity of AP. The possible mechanisms include blocking the afferent of nociceptive stimulation, decreasing the stress response, inhibiting the release of inflammatory mediators, thus inducing the apoptosis of acinar cells and improving the prognosis of the pancreas.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R657.51

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