创伤修复期间参附注射液对肠黏膜的保护作用

背景创伤修复期间胃肠道存在再灌注损伤和灌注不全,引起肠黏膜损伤.目的观察人用等效剂量参附注射液对创伤修复期间家兔肠pH、肠黏膜一氧化氮、丙二醛、Ca2+含量、血清双胺氧化酶的影响.设计以实验动物为观察对象的随机对照实验.单位武汉大学人民医院麻醉科.材料实验于2003-08/10在武汉大学人民医院麻醉学研究室完成,选择健康家兔24只随机分为3组参附注射液治疗组、单纯创伤修复组和对照组,每组8只.干预措施通过股动脉放血2 mL/(kg·min)],平均动脉压降至40mmHg并持续60 min,回输自体血及等量平衡盐液制备兔创伤修复模型;参附注射液组于回输自体血同时先静注参附注射液2.1 mL/kg,随后持续注入参附注射液5 mL/(kg·h).主要观察指标分别于实验前,创伤修复1 h,及再灌注1,3 h检测乙状结肠黏膜内pH、肠黏膜一氧化氮、丙二醛及钙含量、血清双胺氧化酶活性.结果24只家兔均进入结果分析.①参附注射液治疗组再灌注1,3 h肠黏膜pH为7.171±0.102,7.194±0.106,高于单纯创伤修复组(6.920±0.155,6.971±0.165,P＜0.05,P＜0.01)及对照组(7.329±0.038,7.322±0.101,P＜0.05).②参附注射液治疗组再灌注1,3 h血清双胺氧化酶为(35.090±1.184),(32.440±2.884)μkat/L,显著高于单纯创伤修复组(50.994±2.684),(52.377±1.217)μkat/L,P＜0.01]及对照组(15.970±1.734),(16.620±0.767)μkat/L,P＜0.05].③再灌注3 h肠黏膜一氧化氮、丙二醛含量参附注射液治疗组均显著低于单纯创伤修复组(61.8±5.3,72.2±5.8)μmol/g,(68.2±4.9,96.9±8.5)μmol/L,P＜0.05].再灌注3 h肠黏膜Ca2+含量参附注射液治疗组为(2.43±0.27)μnol/L,低于单纯创伤修复组(2.93±0.34)μmol/L,P＜0.05],高于对照组(2.26±0.31)μnol/L,(P＜0.05)].结论给予家兔人用等效剂量的参附注射液,增加了肠黏膜灌注及氧合作用,抑制了肠黏膜一氧化氮活性和清除氧自由基及减轻钙超载,对创伤修复期间肠黏膜具有良好的保护作用.

Protective effect of shenfu injection on intestinal mucosa during shock /resuscitation

BACKGROUND: Reperfusion injury and inadequate perfusion exist,causing the injury of intestinal mucosa during shock / resuscitation.OBJECTIVE: To investigate protective effect of shenfu injection (SFI) in equal dosage for human effect on intestinal mucosal pH (PHi) of sigmoid colon, the contents of nitric oxide (NO), malonialdehyde(MDA) and Ca2+ of intestinal mucosa, activity of serum diamine oxidase(DAO of rabbits during shock/resuscitation.DESIGN:A randomized controlled trial with experimental animals as the subjects.SETTING: DepartmentofAnesthesiology, Renmin Hospital of Wuhan University MATERIALS: The experiment was performed in the Research Institute of Anesthesiology, Renmin Hospital of Wuhan University from August to October in 2003. Twenty-four adult healthy white rabbits were randomly divided into 3 groups with 8 animals for each: Shenfu injection group (SFI group), shock/resuscitation group and control group .INTERVENTIONS: Hemorrhagic shock was induced by blood withdrawal from femoral artery at a rate of 2 mL/kg per minute until MAP dropped to 40 mmHg. MAP was maintained at this level for 60 minutes,then the collected auto-blood and the same volume of balanced salt solution was transfused to the animal for preparing shock/resuscitation model. In SFI group: the animals were given 2.1 mL/kg SFI together with the auto-blood transfusion and followed by a continuous infusion of 5mL/kg SFI per hour.MAIN OUTCOME MEASURES: Intestinal mucosal pH (PHi) of sigmoid colon, NO, MDA and Ca2+ contents of intestinal mucosa, activity of serum DAO were detected before shock (So), 1 hour after shock (S1), 1 hour (R1) and 3 hour (R3) following resuscitation.the R1 reperfusion (7.171±0.102) , and R3 reperfusion (7.194±0.106) of the SFI group were higher than those of the shock/ resuscitation group (6.920±0.155,6.971±0.165,P ＜ 0.05,P ＜ 0.01) and those of the contents of the reperfusion R1 (35.090±1.184) μkat/L and R3 (32.440±2.884) μkat/L of the SFI groups were significantly higher than those of the shock/resuscitation group (50.994±2.684),(52.377±1.217) μkat/L,P＜ 0.01] and of the control group (15.970±1.734), (16.620±0.767)μkat/L,Pgroup were significantly lower than those in the shock/resuscitation group (61.8±5.3,72.2±5.8 ) μmol/g , (68.2±4.9,96.9±8.5) μmol/L ,P＜ 0.05]. Ca2+ content of intestinal mucosa at reperfusion 3 hours in the SFI group (2.43±0.27)μmol/L] was lower than that in the shock/resuscitation group (2.93±0.34)μmol/L,P ＜ 0.05] and higher than that in the control group (2.26±0.31 )μmol/L, (P ＜ 0.05)].CONCLUSION: SFI in equal dosage for human effect could protect intestinal mucosa from shock/resuscitation injury through improving perfusion and oxygenation, inhibit the activity of NO, reduce oxygen free radical and calcium overload, with a good protective effect on intestinal mucosa during shock/resuscitation.