【摘要】 目的研究腹腔置管引流(Abdominal Paracentesis Drainage,APD)对重症急性胰腺炎(Severe Acute Pancreatitis,SAP)大鼠胃肠动力改善的影响。方法大鼠SAP模型通过胰胆管以12 ml/h的速度注入5%牛磺胆酸钠(0.1ml/100 g)完成,小肠推进指数是以10 g/L台盼蓝1.5 ml灌胃后半小时处死大鼠(小肠推进实验)测定小肠台盼蓝推进距离与小肠全长的比。第一部分,30只SD雄性大鼠随机均分为6小时组、12小时组和24小时组,然后进行小肠推进实验,选取三组中小肠推进指数最小的实验组时间点表示大鼠胃肠动力最弱的大概时间点,开展后续实验。第二部分,30只SD雄性大鼠随机分为对照组(假手术组)、模型组(SAP组)、实验组(APD组),每组10只。根据第一部分结果,于造模后24小时进行小肠推进实验,并对比各组大鼠腹腔内大体改变,HE染色观察胰腺病理改变;腹主动脉采血,ELISA法测定大鼠血清中TNF-α、IL-1β、胃动素(motilin,MTL)、胆囊收缩素(cholecystokinin,CCK)以及血管活性肠肽(Vasoactive Intestinal Peptide,VIP)水平。结果对比不同时间点小肠推进指数,发现在SAP造模成功后24小时小肠推进最慢;假手术组未产生腹水,SAP组和APD组均产生腹水;与假手术组比较,SAP组、APD组胰腺组织病理学改变明显,血清TNF-α、IL-1β以及VIP水平均显著升高(P<0.01),而小肠推进指数、MTL及CCK均显著降低(P<0.01);与SAP组比较,APD组胰腺组织病理学改变较轻,血清TNF-α、IL-1β以及VIP水平均降低(P<0.05),而小肠推进指数、血清MTL及CCK均升高(P<0.05)。结论 APD有效地改善了SAP模型大鼠胃肠动力障碍,可能机制与引流出腹水以及其中炎性因子(TNF-α、IL-1β)相关。更多还原

【Abstract】 Objective To study the effect of abdominal paracentesis drainage( APD) on gastrointestinal motility in the rats with severe acute pancreatitis( SAP). Methods The SAP models were produced by injection of 5% sodium taurocholate( 12 ml / h,0. 1 ml /100 g) via the cannulated biliopancreatic duct. For intestinal transit test,1. 5 ml of 10 g / L trypan blue solution was intragastrically gavaged for each rat. 30 min later,rats were sacrificed,and then the ratio of small intestine trypan blue forward distance and small intestine length was measured. Part 1,thirty male SD rats were randomly divided into three groups: 6 hours group( n = 10),12 hours group( n = 10),24 hours group( n = 10),and then selecting point-in-time whose small intestinal transit index was the lowest in the three groups though Intestinal transit test. Part 2,thirty SD rats were randomly and equally divided into 3 groups,i. e. control group,model( SAP) group,drainage( APD) group. Intestinal transit test was executed 24 hours after operation. The condition of abdominal cavity was observed,and pathological changes in pancreas were detected by HE staining. The serum levels of tumor necrosis factor-α( TNF-α),interleukin-1( IL-1β),motilin( MTL),cholecystokinin( CCK),and vasoactive intestinal peptide( VIP) were determined by ELISA. Results The controlgroup did not produce ascites,but SAP and APD groups had. Compared with the control group,the histopathological changes in pancreas were more marked,and serum levels of TNF-α,IL-1β and VIP were significantly higher in SAP group and APD group( P < 0. 01); Compared with the control group,the small intestinal transit index,and serum levels of MTL and CCK were significantly lower in SAP group and APD group( P < 0. 01); Compared with SAP group,the histopathological changes in pancreas were less marked,and serum levels of TNF-α,IL-1β and VIP were significantly lower in APD group( P <0. 05); Compared with SAP group,the small intestinal transit index,and serum levels of MTL and CCK were significantly higher in APD group( P < 0. 05). Conclusion APD can effectively alleviate the gastrointestinal dysmotility in the SAP rats,the mechanism of which may be related to the removing of ascites and inflammatory factors( TNF-α、IL-1β).更多还原