中国急救医学
中國急救醫學
중국급구의학
CHINESE JOURNAL OF CRITICAL CARE MEDICINE
2009年
12期
1105-1108
,共4页
詹剑勇%梅冰%王美堂%霍正禄
詹劍勇%梅冰%王美堂%霍正祿
첨검용%매빙%왕미당%곽정록
丙酮酸乙酯%脓毒症%生存率%肠黏膜屏障
丙酮痠乙酯%膿毒癥%生存率%腸黏膜屏障
병동산을지%농독증%생존솔%장점막병장
Ethyl pyruvate%Sepsis%Survival rate%Intestinal mucosal barrier
目的 观察丙酮酸乙酯(ethyl pyruvate ,EP)干预治疗对脓毒症大鼠生存率和肠黏膜屏障的影响.方法 ①EP对脓毒症大鼠生存率的影响:无特定病原雄性SD大鼠100只随机分为假手术组(A组)、脓毒症组(B组)、EP早期治疗组(C组)及EP延迟治疗组(D组),每组25只,利用盲肠结扎穿孔法(cecal ligation and puncture,CLP)制作大鼠脓毒症模型,各组均于术后6、12、18、24、36、48、60、72 h腹腔内注射给药3 mL,C、D组分别于术后6、12 h开始予EP(40 mg/kg),A、B两组同法予等量林格乳酸钠溶液(ringer lactate solution ,RLS),每隔12 h记录死亡情况,分析比较5 d生存率;②EP对脓毒症大鼠肠黏膜屏障的影响:80只无特定病原雄性SD大鼠随机分为四组,每组20只,分组及给药方法与方法一相同,术后24、48 h各处死10只.测定各时间点血浆D-乳酸、DAO的变化,同时用透射电镜观察术后48 h肠黏膜上皮细胞超微结构的变化.采用Kaplan- Meier生存分析法进行生存分析,多组均数间比较采用单因素方差分析的方法, 多组均数间两两比较采用SNK-q检验,P＜0.05为差异有统计学意义.结果 A、B、C、D四组大鼠5 d生存率分别为100%、24%、68%、56%,与B组相比,C、D组大鼠5 d生存率明显提高(P<0.05),C、D组间差异无统计学意义(P＞0.05);与B组相比,C、D组术后24 h和48 h血浆D-乳酸含量明显下降(P<0.01);与B组相比,C组、D术后24 h和48 h血浆DAO活性明显下降(P<0.01),C、D组术后24、48 h血浆D-乳酸含量、DAO活性差异无统计学意义(P＞0.05);电镜下C、D组肠黏膜上皮细胞损伤较B组明显减轻,细胞间紧密连接较清楚.结论 脓毒症时肠黏膜损伤严重,EP早期与延迟干预治疗能有效保护肠黏膜屏障,提高5 d生存率,具有抗脓毒症作用 .
目的 觀察丙酮痠乙酯(ethyl pyruvate ,EP)榦預治療對膿毒癥大鼠生存率和腸黏膜屏障的影響.方法 ①EP對膿毒癥大鼠生存率的影響:無特定病原雄性SD大鼠100隻隨機分為假手術組(A組)、膿毒癥組(B組)、EP早期治療組(C組)及EP延遲治療組(D組),每組25隻,利用盲腸結扎穿孔法(cecal ligation and puncture,CLP)製作大鼠膿毒癥模型,各組均于術後6、12、18、24、36、48、60、72 h腹腔內註射給藥3 mL,C、D組分彆于術後6、12 h開始予EP(40 mg/kg),A、B兩組同法予等量林格乳痠鈉溶液(ringer lactate solution ,RLS),每隔12 h記錄死亡情況,分析比較5 d生存率;②EP對膿毒癥大鼠腸黏膜屏障的影響:80隻無特定病原雄性SD大鼠隨機分為四組,每組20隻,分組及給藥方法與方法一相同,術後24、48 h各處死10隻.測定各時間點血漿D-乳痠、DAO的變化,同時用透射電鏡觀察術後48 h腸黏膜上皮細胞超微結構的變化.採用Kaplan- Meier生存分析法進行生存分析,多組均數間比較採用單因素方差分析的方法, 多組均數間兩兩比較採用SNK-q檢驗,P＜0.05為差異有統計學意義.結果 A、B、C、D四組大鼠5 d生存率分彆為100%、24%、68%、56%,與B組相比,C、D組大鼠5 d生存率明顯提高(P<0.05),C、D組間差異無統計學意義(P＞0.05);與B組相比,C、D組術後24 h和48 h血漿D-乳痠含量明顯下降(P<0.01);與B組相比,C組、D術後24 h和48 h血漿DAO活性明顯下降(P<0.01),C、D組術後24、48 h血漿D-乳痠含量、DAO活性差異無統計學意義(P＞0.05);電鏡下C、D組腸黏膜上皮細胞損傷較B組明顯減輕,細胞間緊密連接較清楚.結論 膿毒癥時腸黏膜損傷嚴重,EP早期與延遲榦預治療能有效保護腸黏膜屏障,提高5 d生存率,具有抗膿毒癥作用 .
목적 관찰병동산을지(ethyl pyruvate ,EP)간예치료대농독증대서생존솔화장점막병장적영향.방법 ①EP대농독증대서생존솔적영향:무특정병원웅성SD대서100지수궤분위가수술조(A조)、농독증조(B조)、EP조기치료조(C조)급EP연지치료조(D조),매조25지,이용맹장결찰천공법(cecal ligation and puncture,CLP)제작대서농독증모형,각조균우술후6、12、18、24、36、48、60、72 h복강내주사급약3 mL,C、D조분별우술후6、12 h개시여EP(40 mg/kg),A、B량조동법여등량림격유산납용액(ringer lactate solution ,RLS),매격12 h기록사망정황,분석비교5 d생존솔;②EP대농독증대서장점막병장적영향:80지무특정병원웅성SD대서수궤분위사조,매조20지,분조급급약방법여방법일상동,술후24、48 h각처사10지.측정각시간점혈장D-유산、DAO적변화,동시용투사전경관찰술후48 h장점막상피세포초미결구적변화.채용Kaplan- Meier생존분석법진행생존분석,다조균수간비교채용단인소방차분석적방법, 다조균수간량량비교채용SNK-q검험,P＜0.05위차이유통계학의의.결과 A、B、C、D사조대서5 d생존솔분별위100%、24%、68%、56%,여B조상비,C、D조대서5 d생존솔명현제고(P<0.05),C、D조간차이무통계학의의(P＞0.05);여B조상비,C、D조술후24 h화48 h혈장D-유산함량명현하강(P<0.01);여B조상비,C조、D술후24 h화48 h혈장DAO활성명현하강(P<0.01),C、D조술후24、48 h혈장D-유산함량、DAO활성차이무통계학의의(P＞0.05);전경하C、D조장점막상피세포손상교B조명현감경,세포간긴밀련접교청초.결론 농독증시장점막손상엄중,EP조기여연지간예치료능유효보호장점막병장,제고5 d생존솔,구유항농독증작용 .
Objective To observe the effects of ethyl pyruvate (EP) on the survival rate and the intestinal mucosa barrier in septic rats. Methods①Effect of EP on the survival rate of septic rats:one hundred SPF-grade male Sprague-Dawley rats were randomly divided into 4 groups : sham group(group A), sepsis group(group B),early treatment with EP group(group C) and delayed treatment with EP group(group D). A cecum ligation and puncture procedure was used to make sepsis model. Drugs were injected intraperitoneally at 6,12,18,24,36,48,60 and 72 hours after operation. Sham group and sepsis group were administrated with 3ml ringer lactate solution(RLS),whereas early treatment group(6 h after CLP) and delayed treatment group(12 h after CLP) were treated with ringer ethyl pyruvate solution(REPS) 3 mL (EP 40 mg/kg body weight). The survival period of rats was observed within 5 days after operation. ②Effect of EP on the intestinal mucosa barrier in septic rats.: Eighty SPF-grade male Sprague-Dawley rats were randomly divided into 4 groups. Grouping and administration methods were were the same as above.Ten rats from each group were sacrificed 24 and 48 hours after operation. Concentration of D-lactate and activity of DAO in plasma were measured at each phase points and ultrastructure of the intestinal mucosa were observed under electron microscopy 48 hours after operation. Kaplan-Meier test was used for comparing survival. Data were analyzed for significance by one-way ANOVA including SNK-q test. Two-tailed tests of significance were employed and significance was assumed at P<0.05. Results Five day survival rate of group A,B,C and D was 100%,24%, 68%、56% respectively.Compared with group B, 5-day survival rate of rats in group C and D was significantly improved (P<0.05), but no significant differences were found between group C and D (P>0.05). In group C and D, the concentration of D-lactate in plasma was significant lower than that in group B 24 and 48 hours after CLP (P<0.01). The activity of DAO in plasma of group C and D was significant lower than that in group B 24 and 48 hours after CLP (P<0.01). No significant differences in D-lactate concentration and DAO activity were found between group C and D 24 and 48 hours after CLP (P>0.05).Compared with group B, the injury of intestinal epithelial cells in group C and D was significantly reduced, and the tight junctions between epithelial cells were more clearly. Conclusion Intestinal mucosal were injuried severely in sepsis group. Early and delayed treatment with EP can protect the intestinal mucosa barrier and improve 5-day survival rates of rat effectively, so ethyl pyruvate has well anti-septic effect.
