本文選題：腸 + 失血性休克�。� 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 通過觀察七氟烷對巴馬小型豬失血性休克腸屏障功能及腸黏膜水通道蛋白8（Aquaporin8，AQP8）表達(dá)的影響，從而探討七氟烷對其保護(hù)作用及可能的機(jī)制。 方法： 巴馬小型豬32頭，隨機(jī)分為4組，每組8頭，分別為對照組（S組）、失血性休克組（HS組）、七氟烷預(yù)處理組（Pre/Sev組）及七氟烷后處理組（Post/Sev組）。實(shí)驗(yàn)動物術(shù)前禁食禁飲8h，給予丙泊酚3mg/kg實(shí)施麻醉。S組麻醉后經(jīng)股動脈和頸內(nèi)靜脈置管；HS組麻醉置管后建立失血性休克模型；Pre/Sev組麻醉置管后給予2%七氟烷吸入30min后建立失血性休克模型；Post/Sev組于麻醉置管建立失血性休克模型成功后給予2%七氟烷吸入30min。各實(shí)驗(yàn)組均于麻醉前（T0）、失血性休克后30min（T1）、1h（T2）、1.5h（T3）、2h（T4）、3h（T5）、4h（T6）時(shí)間點(diǎn)于頸內(nèi)靜脈采取外周血、記錄血流動力學(xué)指標(biāo)并且測定心輸出量和溫度；ELISA法檢測血清腫瘤壞死因子（TNF-a）、白介素6(IL-6)、D-乳酸、腸脂肪酸結(jié)合蛋白(I-FABP)的含量；失血性休克4h后放血處死實(shí)驗(yàn)動物取腸組織制作病理切片，HE染色觀察各組病理組織學(xué)變化；用干濕比法計(jì)算腸組織的含水量；并且取下腔靜脈血、腸系膜淋巴結(jié)(MLN)、肝、肺、腎、脾組織進(jìn)行細(xì)菌培養(yǎng)，計(jì)算遠(yuǎn)隔器官移位頻率；ELISA法檢測AQP8表達(dá)的變化。采用SPSS19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，實(shí)驗(yàn)數(shù)據(jù)以均數(shù)±標(biāo)準(zhǔn)差(X±s)表示，組間比較采用單因素方差分析，組內(nèi)比較采用重復(fù)測量設(shè)計(jì)的方差分析，兩變量間相關(guān)性采用Pearson相關(guān)分析，以P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1、病理組織學(xué)觀察光鏡顯示，S組腸道黏膜未見明顯變化；HS組腸道黏膜損傷嚴(yán)重，可見腸粘膜出血，腸粘膜層炎細(xì)胞浸潤，腸粘膜上皮細(xì)胞壞死； Pre/Sev組和Post/Sev組損傷明顯減輕，僅見輕度粘膜層腺體擴(kuò)張，中度的上皮層和固有層分離，上皮下間隙輕度水腫，少許的炎細(xì)胞浸潤。 2、血清IL-6和TNF-α含量的變化：與S組相比，HS組、Pre/Sev組和Post/Sev組IL-6和TNF-α含量均顯著升高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。與HS組相比較，Pre/Sev組和Post/Sev組IL-6和TNF-α含量均顯著降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。Pre/Sev組和Post/Sev組比較，IL-6和TNF-α含量差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 3、血清D-乳酸和I-FABP含量的變化：與S組相比，HS組、Pre/Sev組和Post/Sev組D-乳酸和I-FABP含量均顯著升高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；與HS組相比較，Pre/Sev組和Post/Sev組D-乳酸和I-FABP含量明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；Pre/Sev組與Post/Sev組相比較，D-乳酸和I-FABP含量差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 4、遠(yuǎn)隔臟器細(xì)菌移位率：與S組相比，HS組、Pre/Sev組和Post/Sev組遠(yuǎn)隔臟器細(xì)菌移位率顯著增高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；與HS組相比， Pre/Sev組和Post/Sev組遠(yuǎn)隔臟器細(xì)菌移位頻率明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；Pre/Sev組和Post/Sev組間差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 5、腸黏膜AQP8表達(dá)的變化：與S組相比，HS組、Pre/Sev組和Post/Sev組腸黏膜AQP8表達(dá)顯著增高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；與HS組相比， Pre/Sev組和Post/Sev組腸黏膜AQP8含量明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；Pre/Sev組和Post/Sev組間差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 6、腸組織含水量的變化：與S組相比，HS組、Pre/Sev組和Post/Sev組腸組織含水量顯著增高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；與HS組相比， Pre/Sev組和Post/Sev組腸組織含水量明顯降低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；Pre/Sev組和Post/Sev組間差異無統(tǒng)計(jì)學(xué)意義（P＞0.05）。 7、失血性休克組空腸、回腸、結(jié)腸腸黏膜AQP8表達(dá)變化與腸組織含水量進(jìn)行相關(guān)性分析，結(jié)果顯示，二者之間呈正相關(guān)（R2=0.841，0.822，，0.890， P0.05）。 8、失血性休克組血清D-乳酸、I-FABP濃度的變化，與血清炎性因子進(jìn)行相關(guān)分析，結(jié)果顯示血清TNF-α濃度與D-乳酸、I-FABP濃度的變化呈正相關(guān)（R2=0.642，0.697， P0.05），血清IL-6濃度與D-乳酸、I-FABP濃度的變化呈正相關(guān)（R2=0.179，0.856， P0.05）。 結(jié)論： 1、AQP8在失血性休克腸黏膜損傷中參與腸道組織水腫的形成； 2、七氟烷可以減輕失血性休克引起的腸黏膜屏障損傷； 3、七氟烷對失血性休克腸屏障損傷的保護(hù)機(jī)制可能與下調(diào)AQP8表達(dá)，減輕 腸黏膜水腫及抑制炎性反應(yīng)有關(guān)。
[Abstract]:Purpose :

Objective To investigate the effect of heptafluoroalkane on intestinal barrier function and expression of Aquaporin8 ( AQP8 ) in the intestinal mucosal water channel protein 8 ( AQP8 ) of the small porcine hemorrhagic shock .

Method :

Thirty - two groups were randomly divided into four groups : control group ( group S ) , hemorrhagic shock group ( HS group ) , pre / Sev group ( Pre / Sev group ) and group ( Post / Sev group ) .
The hemorrhagic shock model was established after anesthesia with HS group .
The hemorrhagic shock model was established after the Pre / Sev group was intuitized with 2 % of 7 - fluoroalkane after inhalation for 30 min .
The hemodynamic parameters were recorded and the cardiac output and temperature were measured before anesthesia ( T0 ) , 30min after hemorrhagic shock ( T1 ) , 1h ( T2 ) , 1.5h ( T3 ) , 2h ( T4 ) , 3h ( T5 ) and 4h ( T6 ) , respectively .
Serum tumor necrosis factor ( TNF - a ) , interleukin - 6 ( IL - 6 ) , D - lactic acid and intestinal fatty acid binding protein ( I - FABP ) were detected by ELISA .
After 4 hours of hemorrhagic shock , the rats were sacrificed after hemorrhagic shock , pathological sections were prepared from intestinal tissue , and the pathological changes of each group were observed by HE staining ;
calculating the water content of the intestinal tissue by a dry - wet - ratio method ;
and taking inferior vena cava blood , mesenteric lymph node ( MLN ) , liver , lung , kidney and spleen tissue to carry out bacterial culture to calculate distant organ shift frequency ;
The changes of AQP8 expression were detected by ELISA . SPSS 10.0 software was used for statistical analysis . The experimental data was expressed by mean 鹵 standard deviation ( X 鹵 s ) . A single - factor analysis was used to compare the differences between the groups . Pearson correlation was used to analyze the correlation between the two variables .

Results :

1 . Pathohistological observation showed that there was no obvious change in intestinal mucosa of S group .
The intestinal mucosal lesion was severe in HS group , and intestinal mucosal bleeding , infiltration of intestinal mucosal layer inflammatory cells and necrosis of intestinal epithelial cells were observed .
The pre / Sev group and Post / Sev group were significantly reduced , only mild mucosal layer gland dilatation , moderate upper cortical layer and intrinsic layer separation , mild edema of the upper subcutaneous gap , and little inflammatory cell infiltration .

Compared with group S , the levels of IL - 6 and TNF - 偽 in Pre / Sev group and Post / Sev group were significantly lower than those in HS group ( P0.05 ) . There was no significant difference between Pre / Sev group and Post / Sev group ( P > 0.05 ) .

3 . Changes of serum D - lactic acid and I - FABP content : Compared with group S , the contents of D - lactic acid and I - FABP in HS group , Pre / Sev group and Post / Sev group increased significantly ( P0.05 ) .
Compared with HS group , the contents of D - lactic acid and I - FABP decreased significantly in Pre / Sev group and Post / Sev group ( P0.05 ) .
Compared with the Post / Sev group , the contents of D - lactic acid and I - FABP were not statistically significant ( P > 0.05 ) .

4 . Bacterial translocation rate of the distant organs : Compared with the S group , the rate of bacterial translocation was significantly higher in HS group , Pre / Sev group and Post / Sev group than in S group ( P0.05 ) .
Compared with HS group , the frequency of bacterial translocation between Pre / Sev group and Post / Sev group was significantly lower than that of HS group ( P0.05 ) .
There was no significant difference between Pre / Sev group and Post / Sev group ( P > 0.05 ) .

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本文編號：1742170