本文選題：腹部手術(shù) + 血清白蛋白�。� 參考：《昆明醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：通過觀察兔腹部大手術(shù)后早期腸系膜微血管白蛋白滲漏現(xiàn)象,羥乙基淀粉干預(yù),以及腸系膜微血管內(nèi)皮細(xì)胞間隙的變化,測定腸系膜微血管白蛋白和羥乙基淀粉滲漏率,以及血清白蛋白濃度及血清炎性介質(zhì)濃度的變化,探討羥乙基淀粉對兔腹部大手術(shù)后早期微血管白蛋白滲漏的影響機(jī)制。方法：將54只日本大耳兔隨機(jī)分為術(shù)前對照組6只,術(shù)后生理鹽水組24只(6h、24h、48h、72h各6只)和術(shù)后羥乙基淀粉組24只(6h、24h、48h、72h各6只)。兩手術(shù)組均行胃大部切除加胰體尾、脾切除術(shù),術(shù)后所有兔均采用每公斤體重等熱卡、等氮量營養(yǎng)支持,熱量60kca/Kg,由葡萄糖及脂肪提供,分別提供熱量的70%、30%。氮源由復(fù)方氨基酸提供,氮熱比為1：130。此外,生理鹽水組術(shù)后每天給予25ml/Kg的生理鹽水至觀測時(shí)間點(diǎn)；羥乙基淀粉組術(shù)后每天給予6%HES (130,0.4) 25ml/kg至觀測時(shí)間點(diǎn)；對照組(不手術(shù))作為術(shù)前檢測點(diǎn),生理鹽水組及羥乙基淀粉組以術(shù)后(6h、24h、48h、72h)作為檢測點(diǎn),予各檢測點(diǎn)檢測血清白蛋白濃度、血清白細(xì)胞介素-6(Interleukin-6, IL-6)、腫瘤壞死因子-α (Tumour necrosis factor-α, TNF-α)、白細(xì)胞介素-2(Interleukin-2, IL-2)、細(xì)胞間黏附分子-1(intercellular adhesion molecule-1, ICAM-1)、血管內(nèi)皮生長因子(vascular endothelial growth factor, VEGF)、組胺(histamine, HIS)濃度。生理鹽水組予術(shù)后6h、24h、48h、72h靜脈注射異硫氰酸羅丹明B標(biāo)記的牛血清白蛋白(RBITC-BSA),注射后2min在激光共聚焦顯微鏡下觀察兔腸系膜微血管白蛋白的分布、滲漏情況,并計(jì)算微血管白蛋白滲透率；羥乙基淀粉組組予術(shù)后6h、24h、48h、72h先靜脈注射異硫氰酸熒光素標(biāo)記的羥乙基淀粉(FITC-HES),注射后2min在激光共聚焦顯微鏡下觀察兔腸系膜微血管內(nèi)羥乙基淀粉的分布、滲漏情況,然后再注射異硫氰酸羅丹明B標(biāo)記的牛血清白蛋白(RBITC-BSA),注射后2min在同一激光共聚焦顯微鏡視野下觀察兔腸系膜微血管白蛋白的分布、滲漏情況,并計(jì)算微血管白蛋白滲透率；透射電鏡觀察術(shù)前對照組、生理鹽水組術(shù)后48h和羥乙基淀粉組術(shù)后48h之間兔腸系膜微血管內(nèi)皮細(xì)胞間隙的差異。結(jié)果：1、血清白蛋白濃度變化：①生理鹽水組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比均降低,其差異有統(tǒng)計(jì)學(xué)意義(P0.01),其中術(shù)后48h降低最明顯。②羥乙基淀粉組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比均降低,其差異有統(tǒng)計(jì)學(xué)意義(P0.01),其中術(shù)后48h降低最明顯。③兩組組間比較：術(shù)后6h、24h、48h、72h生理鹽水組與羥乙基淀粉組相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。2、血清炎性介質(zhì)濃度比較：(1)血清IL-6：①生理鹽水組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。②羥乙基淀粉組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。③兩組組間比較：術(shù)后6h、24h、48h、72h生理鹽水組與羥乙基淀粉組相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。(2)血清TNF-α:①生理鹽水組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。②羥乙基淀粉組各組組內(nèi)比較：術(shù)后6h與術(shù)前相比差異無統(tǒng)計(jì)學(xué)意義(P0.05),24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。③兩組組間比較：術(shù)后6h、24h、48h、72h生理鹽水組與羥乙基淀粉組相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。(3)血清IL-2：①生理鹽水組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。②羥乙基淀粉組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。③兩組組間比較：術(shù)后6h、24h生理鹽水組與羥乙基淀粉組相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。術(shù)后72h生理鹽水組與羥乙基淀粉組相比差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后48h生理鹽水組與羥乙基淀粉組相比差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(4)血清ICAM-1:①生理鹽水組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。②羥乙基淀粉組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。③兩組組間比較：術(shù)后6h、24h、48h、72h生理鹽水組與羥乙基淀粉組相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。(5)血清VEGF:①生理鹽水組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。②羥乙基淀粉組各組組內(nèi)比較：術(shù)后6h與術(shù)前相比差異無統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。③兩組組間比較：術(shù)后6h、24h、48h、72h生理鹽水組與羥乙基淀粉組相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。(6)血清HIS：①生理鹽水組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。②羥乙基淀粉組各組組內(nèi)比較：術(shù)后6h、24h、48h、72h與術(shù)前相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。③兩組組間比較：術(shù)后6h、24h、48h生理鹽水組與羥乙基淀粉組相比差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。術(shù)后72h生理鹽水組與羥乙基淀粉組相比有差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、兔腸系膜微血管滲漏率的比較：①生理鹽水組白蛋白滲漏率和羥乙基淀粉組白蛋白滲漏率比較,術(shù)后6h、24h、48h、72h滲漏率相比差異均有統(tǒng)計(jì)學(xué)意義(p0.01);②羥乙基淀粉組羥乙基淀粉滲漏率和白蛋白滲漏率比較,術(shù)后6h、24h、48h、72h滲漏率相比差異均有統(tǒng)計(jì)學(xué)意義(pO.01)。4、腸系膜微血管內(nèi)皮細(xì)胞間隙變化：在術(shù)前對照組中,兔腸系膜微血管內(nèi)皮細(xì)胞胞膜完整,連接緊密；在羥乙基淀粉組中,兔腸系膜微血管內(nèi)皮細(xì)胞胞膜較完整,連接較緊密,內(nèi)皮細(xì)胞間形成約0.1 μ m裂隙；在生理鹽水組中,兔腸系膜微血管內(nèi)皮細(xì)胞腫脹明顯,內(nèi)皮細(xì)胞間形成0.2-0.3 μ m裂隙。結(jié)論：1、兔腹部大手術(shù)后早期存在血清白蛋白濃度降低,術(shù)后48h血清白蛋白濃度降至最低；使用羥乙基淀粉(130/0.4)干預(yù)能減輕手術(shù)創(chuàng)傷后血漿白蛋白濃度下降幅度。2、兔腹部大手術(shù)后早期可出現(xiàn)血清炎性介質(zhì)(IL-6、TNF-α、IL-2、ICAM-1、VEGF、HIS)濃度普遍升高；術(shù)后使用羥乙基淀粉干預(yù)可以降低IL-6、TNF-α、 IL-2、ICAM-1、VEGF的濃度,但不能抑制組胺(HIS)濃度升高。3、激光共聚焦顯微鏡觀察到兔腹部大手術(shù)后早期微血管白蛋白和羥乙基淀粉滲漏,且二者都以術(shù)后48h滲漏最明顯,羥乙基淀粉滲漏率較白蛋白低,術(shù)后使用羥乙基淀粉干預(yù)可以減輕腸系膜微血管白蛋白滲漏。4.電鏡下可見術(shù)后早期微血管內(nèi)皮細(xì)胞間隙異常開放。使用羥乙基淀粉干預(yù)可以減少微血管內(nèi)皮細(xì)胞間隙的異常開放。
[Abstract]:Objective: To observe the early mesenteric microvascular albumin leakage, the intervention of hydroxyethyl starch, and the changes in the mesenteric microvascular endothelial cell space, and to determine the leakage of microvascular albumin and hydroxyethyl starch in mesenteric microvessels, the concentration of serum albumin and the concentration of serum inflammatory mediators. The effect of basic starch on the early microvascular albumin leakage after the major abdominal operation in rabbits. Methods: 54 Japanese big ear rabbits were randomly divided into 6 rats in the pre operation control group, 24 rats in the saline group after operation (6h, 24h, 48h, 72h each 6) and 24 hydroxyethyl starch group after operation (6h, 24h, 48h, 72h each 6). The two operation group all underwent gastrectomy plus the tail of pancreas, spleen, spleen and spleen. All rabbits were treated with heat card per kilogram, equal nitrogen nutrition support, heat 60kca/Kg, supplied by glucose and fat, provided 70% of the heat, 30%. nitrogen source was supplied by compound amino acids, the nitrogen heat ratio was 1:130., and 25ml/Kg was given to the physiological saline group to the observation time per day after the operation. The powder group was given 6%HES (130,0.4) 25ml/kg to the observation time every day, and the control group (no operation) was used as the detection point, the saline group and the hydroxyethyl starch group were used as the detection point after the operation (6h, 24h, 48h, 72h), and the serum albumin concentration was detected at every detection point, serum interleukin -6 (Interleukin-6, IL-6), tumor necrosis factor - alpha (T). Umour necrosis factor- alpha, TNF- alpha), interleukin -2 (Interleukin-2, IL-2), intercellular adhesion molecule -1 (intercellular adhesion molecule-1, ICAM-1), vascular endothelial growth factor, histamine concentration. Luo Danming B labeled bovine serum albumin (RBITC-BSA), the distribution, leakage, and permeability of microvascular albumin in rabbit mesenteric microvessel were observed under the laser confocal microscope after the injection of 2min, and the hydroxyethyl starch group was given 6h, 24h, 48h, and 72h first intravenous injection of hydroxyethyl starch labeled with fluorescein isothiocyanate (FITC) in the group of hydroxyethyl starch (FITC). -HES), after the injection of 2min, the distribution of hydroxyethyl starch in the rabbit mesenteric microvessel was observed under the laser confocal microscope, and the leakage was observed and then the bovine serum albumin (RBITC-BSA) was injected with isothiocyanate Luo Danming B. The distribution of the rabbit mesenteric microvascular albumin was observed under the same laser confocal microscope, and the distribution of the microvascular albumin in the rabbit mesentery was observed. Leakage, and calculation of microvascular albumin permeability; transmission electron microscopy to observe the differences in the mesenteric microvascular endothelial cell gap between the 48h and the hydroxyethyl starch group after the operation of the saline group. Results: 1, the change of serum albumin concentration: (1) the comparison of the serum albumin concentration in the saline group: the postoperative 6h, 24h, 48h, 72h and the operation in the saline group The difference was statistically significant (P0.01), and the postoperative 48h decreased most obviously. 2. In the group of hydroxyethyl starch groups, 6h, 24h, 48h, 72h were lower after operation than before operation, and the difference was statistically significant (P0.01), and the postoperative 48h decreased most obviously. (3) the two groups were compared: postoperative 6h, 24h, 48h, 72h physiological saline group. Compared with the hydroxyethyl starch group, the difference was statistically significant (P0.01).2, and the serum levels of inflammatory mediators were compared: (1) serum IL-6: (1) the comparison of 6h, 24h, 48h, 72h in the group after operation was statistically significant (P0.01). (2) the comparison of the groups in the group of hydroxyethyl starch: postoperative 6h, 24h, 48h, 72h and preoperative The difference was statistically significant (P0.01). (3) the comparison between the two groups: postoperative 6h, 24h, 48h, 72h physiological saline group compared with the hydroxyethyl starch group, the difference was statistically significant (P0.01). (2) serum TNF- A: (1) the physiological saline group group comparison: postoperative 6h, 24h, 48h, 72h compared with preoperative statistical significance (P0.01). (2) hydroxyethyl starch Group comparison: there was no significant difference in 6h after operation (P0.05), 24h, 48h, 72h and preoperative differences were statistically significant (P0.01). (3) the two groups were compared: postoperative 6h, 24h, 48h, 72h saline group compared with the hydroxyethyl starch group was statistically significant (P0.01). (3) serum IL-2: 1 physiological saline group, each Comparison in group group: 6h, 24h, 48h, 72h after operation were statistically significant compared with preoperative (P0.01). (2) the comparison of 6h, 24h, 48h, 72h (P0.01) in postoperative 6h, 24h, 48h, 72h compared with preoperative (P0.01). (3) the comparison of postoperative 6H, 24h physiological saline group and hydroxyethyl starch group had statistical difference. Significance (P0.01). Compared with the hydroxyethyl starch group, there was significant difference between the 72h saline group and the hydroxyethyl starch group (P0.05). There was no significant difference between the 48h saline group and the hydroxyethyl starch group after the operation (P0.05). (4) the comparison of the serum ICAM-1: (ICAM-1:) group in the saline group: 6h, 24h, 48h and 72h were statistically significant (P) after operation. 0.01) (0.01) 2 groups in the hydroxyethyl starch group: after the operation, the difference in 6h, 24h, 48h and 72h was statistically significant (P0.01). (3) the comparison between the two groups: postoperative 6h, 24h, 48h, 72h physiological saline group compared with the hydroxyethyl starch group was statistically significant (P0.01). (5) the comparison of serum VEGF: (1) group of saline group: 6 after operation H, 24h, 48h, 72h were statistically significant compared with preoperative (P0.01). 2. There was no significant difference in 6h from preoperative (P0.05), 24h, 48h, 72h were statistically significant (P0.01) compared with preoperative (P0.01). (3) the two groups were compared: postoperative 6h, saline, and hydroxyethyl The difference in starch group was statistically significant (P0.01). (6) serum HIS: (1) the comparison of 6h, 24h, 48h, 72h in each group after operation was statistically significant (P0.01). (2) the comparison of the groups in the group of hydroxyethyl starch: 6h, 24h, 48h, 72h compared with preoperative (P0.01). (3) two groups Comparison: the difference of 6h, 24h, 48h saline group and hydroxyethyl starch group after operation was statistically significant (P0.01). The difference between 72h physiological saline group and hydroxyethyl starch group after operation was statistically significant (P0.05).3, the comparison of the leakage rate of rabbit mesenteric microvascular: (1) the albumin leakage rate in the saline group and the hydroxyethyl starch group white egg Compared with the white leakage rate, the postoperative 6h, 24h, 48h, 72h leakage rates were statistically significant (P0.01). (2) compared with the hydroxyethyl starch leakage rate and the albumin leakage rate in the hydroxyethyl starch group, the postoperative 6h, 24h, 48h, and 72h leakage rates were statistically significant (pO.01).4, the mesenteric microvascular endothelial cell gap changes: in the pre operation control group In the group of hydroxyethyl starch, the membrane of the rabbit mesenteric microvascular endothelial cells was more complete and closely connected, and the endothelial cells formed about 0.1 M fissure in the hydroxyethyl starch group. In the saline group, the rabbit mesenteric microvascular endothelial cells were swollen obviously and the endothelial cells formed 0.2-0.3 mu m. Conclusions: 1. 1, the serum albumin concentration decreased in the early stage after the major abdominal operation and the concentration of serum albumin decreased to the lowest level after operation. The intervention of hydroxyethyl starch (130/0.4) could reduce the decrease of plasma albumin concentration of.2 after the operation, and the serum inflammatory mediators (IL-6, TNF- a, IL-2, ICAM-1) could be found at the early stage of the major abdominal operation in rabbits. The concentration of VEGF, HIS) was generally elevated, and the concentration of IL-6, TNF- a, IL-2, ICAM-1, VEGF could be reduced after the intervention of hydroxyethyl starch, but the concentration of histamine (HIS) could not be inhibited and.3 was not inhibited. The early microvascular albumin and hydroxyethyl starch leakage was observed by laser confocal microscope after the major operation of the rabbit abdomen, and the two were most obvious in the postoperative 48h leakage. The leakage rate of hydroxyethyl starch is lower than that of albumin. The intervention of hydroxyethyl starch after operation can reduce the microvascular albumin leakage in mesenteric microvessel.4. under the electron microscope, and it can be seen that the early microvascular endothelial gap in the microvascular spaces is abnormal opening. The intervention of hydroxyethyl starch can reduce the abnormal opening of the intercellular space of microvascular endothelial cells.

【學(xué)位授予單位】：昆明醫(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)】：R656

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8 劉玲,劉蔚然,李錦成;術(shù)中輸血與輸羥乙基淀粉對人體安全性的研究[J];天津醫(yī)藥;2005年09期

9 江偉,張暉,王愛忠;羥乙基淀粉法測定血容量的評估[J];上海第二醫(yī)科大學(xué)學(xué)報(bào);2005年01期

10 周欣;張曉樂;;羥乙基淀粉擴(kuò)容液臨床研究進(jìn)展[J];中國藥學(xué)雜志;2007年09期

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3 章蔚;方才;謝言虎;李娟;;不同劑量6%羥乙基淀粉130/0.4預(yù)先給藥對大鼠內(nèi)毒素性急性肺損傷的影響[A];2008年第七次華東六省一市麻醉學(xué)學(xué)術(shù)會(huì)議暨浙江省麻醉學(xué)術(shù)年會(huì)論文匯編（下冊）[C];2008年

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8 趙振龍;古妙寧;肖金訪;劉高望;肖華平;徐翔;;羥乙基淀粉在兔自體腎移植腎組織的沉積及其對腎臟功能的影響[A];2008年中華醫(yī)學(xué)會(huì)全國麻醉學(xué)術(shù)年會(huì)論文匯編[C];2008年

9 蔣鑫;陳純波;方明;江穩(wěn)強(qiáng);朱高峰;曾紅科;;羥乙基淀粉對腦缺血再灌注大鼠血漿膠體滲透壓及顱內(nèi)壓等的影響[A];中華醫(yī)學(xué)會(huì)第五次全國重癥醫(yī)學(xué)大會(huì)論文匯編[C];2011年

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2 袁洪雨;羥乙基淀粉品質(zhì)升級(jí)路[N];醫(yī)藥經(jīng)濟(jì)報(bào);2011年

3 本報(bào)記者 楊俊堅(jiān);慎用羥乙基淀粉[N];醫(yī)藥經(jīng)濟(jì)報(bào);2014年

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5 齊都藥業(yè);羥乙基淀粉——質(zhì)量標(biāo)準(zhǔn)研究比肩歐盟水平[N];醫(yī)藥經(jīng)濟(jì)報(bào);2012年

6 記者 李雪墨;關(guān)注含羥乙基淀粉類藥品安全風(fēng)險(xiǎn)[N];中國醫(yī)藥報(bào);2014年

7 王娟;康隆藥業(yè)：創(chuàng)新帶來大發(fā)展[N];焦作日報(bào);2008年

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9 本報(bào)記者 靖九江;臨床應(yīng)減用慎用羥乙基淀粉類藥物[N];中國醫(yī)藥報(bào);2014年

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4 李兆凱;羥乙基淀粉130/0.4氯化鈉注射液聯(lián)合甘露醇對創(chuàng)傷性腦水腫患者脫水療效的觀察[D];泰山醫(yī)學(xué)院;2014年

5 李星;羥乙基淀粉對兔腹部大手術(shù)后早期微血管白蛋白滲漏影響機(jī)制的研究[D];昆明醫(yī)科大學(xué);2015年

6 鄒小麗;羥乙基淀粉130/0.4質(zhì)量檢測方法的建立與穩(wěn)定性研究[D];山東大學(xué);2012年

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10 孫宇;輸注6%羥乙基淀粉（200/0.5）對血漿白細(xì)胞介素-6、白細(xì)胞介素-10的影響[D];中國醫(yī)科大學(xué);2006年

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