一种新的腹腔粘连动物模型及其关联指标的定量分析

目的制作一种新的大鼠腹腔粘连模型,并确定腹腔渗液中组织纤溶酶原激活物活性(PAA)是否具有判断粘连形成的能力.方法大鼠随机分为2组,麻醉后不作任何消毒,打开腹腔,找到回盲部.距盲端约1～2 cm处结扎,剪去盲端的多余部分,挤去敞口盲端内的肠内容物,不作消毒,放回腹腔.在腹腔内放置直径约4 mm的引流软管.作两层缝合.皮肤层缝合前,用药组注入抗粘连组方(AMD)(尿囊素+甲硝唑+地塞米松),剂量为1.5 ml·100 g-1体重.对照组注射等容量5 % GS.6 h后抽取腹腔液1 ml,拨除引流管.1 w后脱臼处死大鼠,打开腹腔检查粘连的形成及其程度.用相关操作特征图 (ROC) 分析PAA是否具有判断粘连形成的能力.结果对照组的20只大鼠均形成腹腔粘连,腹腔渗液量为(1.25±0.09) ml,WBC(×103) =(23.1±6.6) mm3,PAA=(0.9±0.4) IU·ml-1.用药组没有形成腹腔粘连(0/20),腹腔渗液量为(0.52±0.04) ml (P<0.01),WBC (×103) 为(10.6±4.2) mm3 (P<0.01), PAA 为(23.1±6.6) IU·ml-1(P<0.01).由于此3药联用的抗粘连作用与腹腔炎性渗液量减少,抗菌抗炎作用,以及提高渗液中PAA有关,从而反映了本模型的形成机理.ROC分析认为, PAA可作为判断粘连是否形成的重要指标,当PPA>1.24 IU·ml-1时,粘连不易形成,反之则较易形成.结论本动物模型是研究大鼠腹腔粘连的有效工具,腹腔渗液中PAA活性的变化对大鼠腹腔粘连的形成具有判断能力.

A novel animal model of intra-abdominal adhesion and quantitative evaluation with related indices

Aim To set up a novel animal model of intra-abdominal adhesion and to determine whether the tissue plasminogen activator activity (PAA) in exudate can be taken as an indicator to judge the formation of the adhesion. Methods　Rats were randomly divided into 2 groups. Each animal in both groups was opened the abdominal cavity via midline laparotomy without any disinfectant measures. 2-cm section from the cecal end was clamped and ligated, 1-cm cecum of the section was cut, and another 1-cm end from the ligated site was kept. After the content in the end was extruded, the cecum was put back without using any antibacterial agent. Before the skin closure, an effective combination AMD (allantoin, metronidazole and dexamethasone in combination), was given (ip) according to 1.5 ml per 100 g body weight (60.6 mg·kg-1). The control group was injected (ip) the same volume of normal saline. After 6 h, the exudate was extracted from drainage-tube, with the rats varying posture, and after 1 kw, the rats were killed for examining the intra-abdominal adhesion. The values of PAA of exudate in both groups were analyzed by the relative operating characteristic curve (ROC). Results　In the control group, all 20 rats formed the adhesions, the amount of exudate=(1.25±0.09) ml, the number of WBC(×103)=(23.1±6.6) mm3 and PAA=(0.9±0.4) IU·ml-1 in the exudate of abdominal cavity. In AMD group, however, there was not the adhesion formations (0/20), the amount of exuade was (0.52±0.04) ml (P<0.01), the number of WBC (×103) (10.6±4.2) mm3 (P<0.01), and PAA (23.1±6.6) IU·ml-1(P<0.01) in exuade.ROC analysis indicated that if PAA >1.24 IU·ml-1 in the exuade, the adhesion was difficult to form, and vice versa. Conclusion　This animal model can be taken as an effective tool to evaluate the human adhesion related to multi-links on the pathogenesis, and the PAA in exudate an indicator to judge intra-abdominal adhesion formation.