發(fā)布時(shí)間：2018-03-31 00:12

  本文選題：舒芬太尼　切入點(diǎn)：酮咯酸氨丁三醇　出處：《延邊大學(xué)》2017年碩士論文

【摘要】：目的:探討舒芬太尼和酮咯酸氨丁三醇兩種術(shù)后鎮(zhèn)痛藥對(duì)小鼠腹部術(shù)后的胃腸道功能的影響及其機(jī)制。方法:(1)取40只雄性昆明種小鼠(6-7周,體重28-35g),隨機(jī)分為空白對(duì)照組(C組);手術(shù)模型組(P組):進(jìn)行腹部手術(shù);手術(shù)+舒芬太尼組(手術(shù)+SF組):術(shù)后給予舒芬太尼鎮(zhèn)痛泵泵注,持續(xù)鎮(zhèn)痛48小時(shí);手術(shù)+舒芬太尼+酮咯酸氨丁三醇組(手術(shù)+SF+D組):術(shù)后給予舒芬太尼+酮咯酸氨丁三醇鎮(zhèn)痛泵泵注,持續(xù)給藥48小時(shí),每組10只。術(shù)后48小時(shí)鎮(zhèn)痛結(jié)束后采用墨汁排空測(cè)定法測(cè)定各組小鼠的術(shù)后小腸推進(jìn)率。(2)術(shù)后48小時(shí),檢測(cè)小腸組織勻漿中髓過(guò)氧化物酶(MPO)值;而后眼球采血后處死小鼠,用ELISA方法測(cè)定小鼠血清中TNF-α、IL-1β和IL-10的含量;采用流式細(xì)胞術(shù)檢測(cè)小鼠脾臟中CD4+CD25+Foxp3+Treg細(xì)胞的百分比。(3)舒芬太尼(5ng\ml)與舒芬太尼(5ng\ml)+酮咯酸氨丁三醇(5mg\ml)在有無(wú)脂多糖(LPS)(1μg\ml)的情況下,與巨噬細(xì)胞共同培養(yǎng)6小時(shí),用RT-PCR方式測(cè)定各組巨噬細(xì)胞的IL-6、TNF-α和IL-1β的mRNA含量,另與巨噬細(xì)胞共同培養(yǎng)48小時(shí)后,用ELISA方式測(cè)定細(xì)胞上清液中TNF-α、IL-1β和IL-10細(xì)胞因子的含量。結(jié)果:(1)與C組比較,各組小腸推進(jìn)率均下降,具有統(tǒng)計(jì)學(xué)差異(均p0.01),其中P組最明顯。與P組比較,手術(shù)+SF組小腸推進(jìn)率(0.375±0.04 vs 0.349±0.08)略下降,但無(wú)顯著性差異,而手術(shù)+SF+D組小腸推進(jìn)率(0.375±0.04vs0.438±0.07)明顯上升,有顯著性差異(p0.01)。(2)與C組相比,各組中MPO的活性均顯著增加,有顯著性差異(均p0.01);與P組比較,手術(shù)+SF組和手術(shù)+SF+D組小腸組織MPO活性(7.03±0.53 vs 6.53±0.47,7.03±0.53vs4.56±0.61)均下降,有顯著性差異(p0.05,p0.01)。(3)①與 C 組相比,P 組血清 IL-1β和 TNF-α含量(2.18±0.86 pg\ml vs 15.17±1.67pg\ml、8.01±2.51pg\mlvs55.58±4.14pg\ml)均增加,有顯著性差異(p0.01)。與 P 組(15.17±1.67pg\ml、55.58±4.14pg\ml)比較,手術(shù)+SF 組 IL-1β、TNF-α含量(12.73±1.27pg\ml、42.01±5.81pg\ml)降低,有統(tǒng)計(jì)學(xué)差異(p0.05,p0.01),而手術(shù)+SF+D 組中 IL-1β、TNF-α含量(8.73±1.15 pg\ml、31.85±2.92 pg\ml)明顯下降,有顯著性差異(p0.01);②與 C 組(109.4±13.09pg\ml)相比較,P 組(165.30±10.34pg\ml)、手術(shù)+SF 組(168.39±11.35 pg\ml)和手術(shù)+SF+D 組(203.58±15.98 pg\ml)血清中 IL-10的含量均增加(p0.05,p0.01)。(4)與 C 組(4.418±0.237)相比較,P 組(4.876±0.181)、手術(shù)+SF 組(4.924±0.198)、手術(shù)+SF+D 組(5.464±0.413)小鼠脾臟細(xì)胞中 CD4+CD25+Foxp3+Treg細(xì)胞的含量百分比有所上升(p0.05,p0.01)。(5)舒芬太尼對(duì)LPS刺激6小時(shí)后的小鼠腹腔巨噬細(xì)胞中TNF-α、IL-6、IL-1β的mRNA的表達(dá)減少(p0.05,p0.05,p0.01)。舒芬太尼+酮咯酸氨丁三醇對(duì)LPS刺激6小時(shí)后的小鼠腹腔巨噬細(xì)胞中促炎癥因子TNF-α、IL-6、IL-1β的mRNA的表達(dá)均明顯減少(均p0.01)。舒芬太尼對(duì)LPS刺激48小時(shí)后的小鼠腹腔巨噬細(xì)胞中TNF-α和IL-1β的分泌減少(p0.05,p0.01);舒芬太尼+酮咯酸氨丁三醇對(duì)LPS刺激48小時(shí)后的小鼠腹腔巨噬細(xì)胞中TNF-α和IL-1β的分泌明顯減少,而IL-10的分泌明顯增加(均p0.01)。結(jié)論:1、舒芬太尼+酮咯酸氨丁三醇聯(lián)合用于術(shù)后鎮(zhèn)痛,可以提高術(shù)后胃腸道蠕動(dòng)功能。其機(jī)制可能與下調(diào)促炎癥因子TNF-α、IL-6、IL-1β的表達(dá),上調(diào)抗炎癥因子IL-10的表達(dá)有關(guān)。2、舒芬太尼+酮咯酸氨丁三醇聯(lián)合用于術(shù)后鎮(zhèn)痛,具有一定的抗炎作用。其機(jī)制可能為提高外周免疫系統(tǒng)中CD4+ CD25+Foxp3+調(diào)節(jié)性T細(xì)胞以及降低MPO,從而抑制了炎癥反應(yīng)。
[Abstract]:Objective : To investigate the effect and mechanism of postoperative analgesia on gastrointestinal function of mice after abdominal surgery . Methods : ( 1 ) 40 male Kunming mice ( 6 - 7 weeks , weight 28 - 35g ) were randomly divided into blank control group ( group C ) . After 48 hours after operation , the contents of TNF - 偽 , IL - 1尾 and IL - 10 were measured . Compared with group C , MPO activity increased significantly in each group ( P0.01 ) . Compared with group C , MPO activity ( 7.03 鹵 0.53 vs 6.53 鹵 0.47 , 7.03 鹵 0.53 vs 6.53 鹵 0.47 , 7.03 鹵 0.53 vs 6.53 鹵 0.47 , 7.03 鹵 0.53 v4.56 鹵 0.61 ) decreased significantly ( p < 0.05 , p0.01 ) . ( 3 ) Compared with group C , the levels of IL - 1尾 and TNF - 偽 in group P were significantly lower than those in group C ( 15.17 鹵 1.67pgml , 55.58 鹵 4.14pgml ) . There was a significant difference ( P < 0.01 ) . Compared with group C ( 15.17 鹵 1.67pgml , 55.58 鹵 4.14pgml ) , there was significant difference ( P < 0.01 ) . 鈶，

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