大黄附子汤加味对脓毒症大鼠小肠运动水平及黏膜通透性的影响
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摘要
目的观察温下法对脓毒症大鼠胃肠运动水平及肠黏膜通透性的影响。方法 48只SPF级Wistar大鼠随机分为正常对照组10只;其余38只大鼠采用盲肠结扎穿孔法复制大鼠脓毒症模型。对造模成功的36只大鼠随机分为模型对照组、大黄附子汤加味组(中药组)与枸橼酸莫沙必利组(西药组)各12只。造模成功后各组大鼠均禁食不禁水饲养,中药组大鼠予大黄附子汤加味中药灌胃,西药组给予枸橼酸莫沙必利灌胃,正常对照组与模型对照组予等量灭菌注射用水灌胃。造模成功24 h后观察各组大鼠死亡率,对存活大鼠采用小肠碳末推进百分率评估小肠动力学,观察小肠黏膜病理改变并评分;ELISA方法检测血清D-乳酸及血清降钙素原(PCT)、胃泌素(GAS)及胃动素(MTL)水平。结果死亡率比较:正常对照组<中药组<模型组和西药组(P<0.05)。小肠黏膜损伤指数、D-乳酸及PCT水平比较:正常对照组<中药组<模型组和西药组(P<0.05)。小肠传输率、MTL及GAS比较:正常对照组>中药组和西药组>模型对照组(P<0.05),小肠传输率、MTL及GAS在中药组和西药组间差异无统计学意义(P>0.05)。结论温下法可能通过调节肠道运动和肠黏膜通透性调节炎症状态发挥治疗脓毒症的作用。
Objective: To investigate the effects of modified Dahuang Fuzi Decoction(m DHFZD) on intestinal motility and mucosal permeability in sepsis rats. Methods: 10 among 48 SPF Wistar rats was taken as the normal control group. In the remaining 38 rats,the sepsis model was established with cecum ligation perforation method.36 successful modeling sepsis rats were randomly divided into the model control group,the m DHFZD group(the Chinese Medicine Group,CMG) and Mosapride Citrate group(Western medicine group,WMG),12 cases in each.After successful modeling,rats in each group were raised with water feeding and without food. Rats in CMG were filled the stomach with m DHFZD(4 mg/kg,2 times/24 hours) and rats in WMG were filled the stomach with Mosapride Citrate(1.5 mg/kg,2 times/24 hours),while the normal control group and model control group were filled the stomach with the equal amount of sterilizing water. 24 hours after successful modeling,the mortality rate of rats in each group was observed. The small intestine kinetics was evaluated by the percentage of small intestinal carbon propelling in the survival rats,and the pathological changes of the small intestinal mucosa were observed and the scores were observed. Serum D-lactic acid,PCT,Gastrin(GAS) and Motilin(MTL) levels were detected by ELISA. Results: The mortality rate was in the normal control groupCMG and WMG>the model control group(P < 0.05). There were no statistical differences between CMG and WMG in the intestinal transmission rate,MTL and GAS(P > 0.05). Conclusion: Warm purgative therapy may regulate the inflammatory state by regulating the intestinal movement and intestinal mucosal permeability in the treatment of sepsis rats.
Objective: To investigate the effects of modified Dahuang Fuzi Decoction(m DHFZD) on intestinal motility and mucosal permeability in sepsis rats. Methods: 10 among 48 SPF Wistar rats was taken as the normal control group. In the remaining 38 rats,the sepsis model was established with cecum ligation perforation method.36 successful modeling sepsis rats were randomly divided into the model control group,the m DHFZD group(the Chinese Medicine Group,CMG) and Mosapride Citrate group(Western medicine group,WMG),12 cases in each.After successful modeling,rats in each group were raised with water feeding and without food. Rats in CMG were filled the stomach with m DHFZD(4 mg/kg,2 times/24 hours) and rats in WMG were filled the stomach with Mosapride Citrate(1.5 mg/kg,2 times/24 hours),while the normal control group and model control group were filled the stomach with the equal amount of sterilizing water. 24 hours after successful modeling,the mortality rate of rats in each group was observed. The small intestine kinetics was evaluated by the percentage of small intestinal carbon propelling in the survival rats,and the pathological changes of the small intestinal mucosa were observed and the scores were observed. Serum D-lactic acid,PCT,Gastrin(GAS) and Motilin(MTL) levels were detected by ELISA. Results: The mortality rate was in the normal control group
引文
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[19]郭帅,路晓光,战丽彬,等.大黄附子汤对大鼠失血性休克复苏后肠黏膜屏障的保护作用[J].中华卫生应急电子杂志,2016,2(1):37-42.
[20]陈威,黄庆仪,蒙宇华.大黄附子汤对急性胰腺炎患者血清IL-22及IL-13表达的影响[J].西部中医药,2016,29(5):1-4.
[2]宋麦芬,杨思雯,郭玉红,等.Sepsis3.0诊断标准下ICU脓毒症患者中医虚实证素对预后评估的探讨[J].中国中医急症,2016,25(12):2238-2240,2264.
[3]赵国桢,赵京霞,陈腾飞,等.近年中医文献中药治疗脓毒症的用药情况分析[J].中国中医急症,2017,26(5):764-767.
[4]刘福生,方晓磊,刘陟,等.大黄类制剂治疗脓毒症急性胃肠损伤的疗效:基于随机对照临床试验的Meta分析[J].中国中西医结合急救杂志,2016,23(5):484-489.
[5]Yufen Wei,Lei Shan,Liming Qiao,et al.Protective effects of Huang-Lian-Jie-Du-Tang against polymicrobial sepsis induced by cecal ligation and puncture in rats[J].Evid Based Complement Alternat Med,2013(2013):909624.
[6]姚咏明,张艳敏.脓毒症发病机制最新认识[J].医学研究生学报,2017,30(7):678-683.
[7]Mittal R,Coopersmith CM.Redefining the gut as the motor of critical illness[J].Trends Mol Med,2014,20(4):214-223.
[8]Klingensmith NJ,Coopersmith CM.The gut as the motor of multiple organ dysfunction in critical illness[J].Crit Care Clin,2016,32(2):203-212.
[9]Eleni Sertaridoua,Vasilios Papaioannoua,George Koliosb,et al.Gut failure in critical care:old school versus new school[J].Annals of Gastroenterology,2015(28):309-322.
[10]中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[11]范铁兵,杨志旭.危重病胃肠功能障碍的中医辨证要素及证型分布规律研究[J].中国中医急症,2012,21(7):1064-1065
[12]方晓磊,王苏妹,李金霞.危重症急性胃肠损伤与温下法研究[J].中国医药导报,2014,11(23):87-89.
[13]张秋峰.液体复苏后24 h胃管注入大黄附子汤联合西医基础治疗对急诊ICU脓毒症患者胃肠功能改善的作用[J].中国全科医学,2017,20(S1):226-228.
[14]李雄辉,张东山.大黄附子汤治疗脓毒症胃肠功能障碍临床研究[J].河北中医,2017,39(3):356-360.
[15]程爱斌,张军伟,谢宇曦,等.卡巴胆碱对MODS病人肠功能障碍的治疗作用(英文)[J].药物生物技术,2015,22(5):432-435.
[16]秦龙,刘大为.严重感染患者早期血D-乳酸水平对临床预后的影响[J].中华临床营养杂志,2009,17(3):136-139.
[17]Poeze M,Solberg BC,Greve JW,et al.Gastric Pg CO2and Pga CO2gap arerelated to D-lactate and not to L-lactate levels in patients with septic shock[J].Intensive Care Med,2003,29(11):2081-2085.
[18]赵平,凌亦凌.胃肠激素与危重症胃肠功能障碍的研究进展[J].中国危重病急救医学,2006,18(10):634-636.
[19]郭帅,路晓光,战丽彬,等.大黄附子汤对大鼠失血性休克复苏后肠黏膜屏障的保护作用[J].中华卫生应急电子杂志,2016,2(1):37-42.
[20]陈威,黄庆仪,蒙宇华.大黄附子汤对急性胰腺炎患者血清IL-22及IL-13表达的影响[J].西部中医药,2016,29(5):1-4.