多器官功能不全综合征胃肠动力障碍与Cajal间质细胞关系及大承气冲剂治疗机理
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摘要
目的：研究多器官功能不全综合征(MODS)导致胃肠运动功能障碍的发生机制，探讨大承气冲剂治疗MODS的作用机理。材料和方法：Wistar大鼠111只，随机分为正常对照组、MODS模型组和大承气冲剂治疗组。用以下方法检测胃肠运动功能：通过炭末推进实验测定胃肠通过指数，测量小肠肠管周径，观察胃体、胃窦和小肠在体肌电慢波频率和振幅的变化以及胃体、胃窦和小肠离体肌条自发性收缩活动的频率和振幅变化。结果：MODS组与正常组比较：胃肠通过指数明显下降；肠管周径显著增大；MODS组胃体、胃窦、小肠肌电慢波频率和振幅较正常组均明显减慢和降低；MODS组胃体、胃窦、小肠肌条自主收缩慢波频率和振幅都较正常组明显变慢和下降。治疗组与MODS组比较：死亡率明显下降；胃肠通过指数显著增加；小肠周径明显减小；治疗组胃体、胃窦、小肠肌电慢波频率和振幅均较MODS组明显增加和升高；治疗组胃体、胃窦、小肠肌条自主收缩慢波频率和振幅均较MODS组明显增快和增高。结论：MODS可引起胃肠运动障碍。大承气冲剂可加快胃肠传输速度，增强胃肠蠕动，有效改善胃肠运动障碍，有效地防治MODS，降低死亡率。
Objective: To investigate the mechanism of gastrointestinal motility dysfunction induced by multiple organ dysfunction syndrome (MODS) and the mechanism of Dachengqi granula for treatment of MODS. Materials and Methods: One hundred and eleven Wistar rats were randomly divided into three groups, which were the normal group, the MODS group, and the group treated with Dachengqi granula. The following methods were used to detect the gastrointestinal function: (1)to detecte the gastrointestinal transit index by carbo medicinalis progradation experiment; (2)to measure the circumference of small intestine; (3)to record the frequency and amplitude of slow wave in myoelectricity of gastric corpus, gastric antrumin and intestine in vivo; (4)to record the frequency and amplitude of spontaneous contraction of gastric corpus, gastric antrum and intestinal muscle strip in vitro. Result: Compared the result of the MODS group with the normal group: the gastrointestinal transit index was obviously
reduced, and the circumference of small intestine was significantly enlarged. The frequency and amplitude of slow wave in myoelectricity of gastric corpus, gastric antrum and intestine of the MODS group were slower and lower than the normal group. The frequency and amplitude of spontaneous contraction of gastric corpus, gastric antrum and intestinal muscle strip were decreased and
descend. Compared the result of the therapeutic group with the MODS group: the mortality was decreased, the gastrointestinal transit index was obviously increased, and the circumference of small intestine was reduced. The frequency and amplitude of slow wave in gastric corpus, gastric antrum and intestine of the therapeutic group were faster and higher than the MODS group. The frequency and amplitude of spontaneous contraction of gastric corpus, gastric antrum and intestinal muscle strip were raised and enhanced. Conclusion: Gastrointestinal motility dysfunction can be caused by MODS. Dachengqi granula can improve the gastrointestinal motility dysfunction, accelerate the gastrointestinal transmission velocity, increase vermiculation and reduce mortality rate. There were obvious effect on the prophylaxis and the treatment of MODS.
Objective: To investigate the mechanism of gastrointestinal motility dysfunction induced by multiple organ dysfunction syndrome (MODS) and the mechanism of Dachengqi granula for treatment of MODS. Materials and Methods: One hundred and eleven Wistar rats were randomly divided into three groups, which were the normal group, the MODS group, and the group treated with Dachengqi granula. The following methods were used to detect the gastrointestinal function: (1)to detecte the gastrointestinal transit index by carbo medicinalis progradation experiment; (2)to measure the circumference of small intestine; (3)to record the frequency and amplitude of slow wave in myoelectricity of gastric corpus, gastric antrumin and intestine in vivo; (4)to record the frequency and amplitude of spontaneous contraction of gastric corpus, gastric antrum and intestinal muscle strip in vitro. Result: Compared the result of the MODS group with the normal group: the gastrointestinal transit index was obviously
reduced, and the circumference of small intestine was significantly enlarged. The frequency and amplitude of slow wave in myoelectricity of gastric corpus, gastric antrum and intestine of the MODS group were slower and lower than the normal group. The frequency and amplitude of spontaneous contraction of gastric corpus, gastric antrum and intestinal muscle strip were decreased and
descend. Compared the result of the therapeutic group with the MODS group: the mortality was decreased, the gastrointestinal transit index was obviously increased, and the circumference of small intestine was reduced. The frequency and amplitude of slow wave in gastric corpus, gastric antrum and intestine of the therapeutic group were faster and higher than the MODS group. The frequency and amplitude of spontaneous contraction of gastric corpus, gastric antrum and intestinal muscle strip were raised and enhanced. Conclusion: Gastrointestinal motility dysfunction can be caused by MODS. Dachengqi granula can improve the gastrointestinal motility dysfunction, accelerate the gastrointestinal transmission velocity, increase vermiculation and reduce mortality rate. There were obvious effect on the prophylaxis and the treatment of MODS.
引文
1 次秀丽，王宝恩，张淑文，等．LPS+TNF-α致休克大鼠胃肠运动及屏障功能的改变．世界华人消化杂志，1999，7(6)：510-512．
2 崔克亮，曹书华，王今达．大承气汤对多器官功能障碍综合征防治作用的临床研究．中国中西医结合急救杂志，2003，10(1)：12-15．
3 李伟，齐清会，雷少鸣．中药抗炎灵对腹部外科多器官功能障碍综合征患者胃肠激素改变的影响．中国中西医结合急救杂志，2003，10(1)：19-21．
4 Hasssoun HT, Kone BC, Mercer DW, et al. Post-injury multiple organ failure: the role of the gut. Shock, 2001, 15(1): 1-10.
5 Moore FA. The role of the gastrointestinal tract in post injury multiple organ failure. Am J Surg, I999, 178(6): 449-453.
6 陈德昌，杨兴易，景炳文，等．大黄对多器官功能障碍综合征治疗作用的临床研究．中国中西医结合急救杂志，2002，9(1)：6-8．
7 武若君，李秦，刘京涛，等．大承气汤灌肠在多器官功能障碍综合征中的临床应用．中国现代医学杂志，2003，13(2)：76-77．
8 Rombeau JL, Takala J. Summary of round table conference: gut dysfunction in critical illness. Intens Care Med, 1997, 23: 476-486.
9 Beal AL, Cerra FB. Multiple organ failure in the1990s: systemic inflammatory response and organ dysfunction. JAMA, 1994, 271: 226-233.
10 Gennart R, Alexander JM. Effects of hyperoxia on bacteria translocation and mortality during gut derived sepsis. Arch Surg, 1996, 131: 57-62.
11 王鹏巨，吴勤，余开远，等．多脏器功能障碍综合征发病过程的临床研究．中国危重病急救医学，1999，1(1)：491-493．
12 高士杰，刘峰，王继文等．大黄对创伤性休克患者胃肠功能障碍及多器官功能不全综合征的治疗作用．中华创伤杂志，2002，19(10)：586-588．
13 陈德昌，景炳文，杨建东，等．大黄对胃肠动力学影响的基础和临床研究．中国危重病急救医学，1997，9(7)：411-413．
14 屠伟峰，肖光夏．胃肠功能障碍的研究现状．消化外科，2002，1(1)：66-69．
15 牟宜坤，李玛琳，杨为民．大黄对胃肠道作用及其机制探讨．医学综述，2003，9(2)：125-126．
16 Gareth Ackland, Michael PW Grocott, Michael G Mythen. Understanding gastrointestinal perfusion in critical care: so near, and yet so far. Crit Care 2000, 4: 269-281
17 Nieuwenhuijzen GAP, Deitch EA, Gorsi RJA. The relationship between gut - derived bacteria and the development of the multiple organ dysfunction syndrome. J Anat, 1996, 189: 537-548.
18 刘峰，高士杰，胡慧刚，等．大黄治疗休克后胃肠功能障碍的临床研究．中国急救医学，2003，23(1)：38-39．
19 Billiar TR. Nitric oxide. Novel biology with clinical relevance. Ann Surg, 1995,221(4): 339-349.
20 陈德昌，景炳文，杨建东，等．大黄对胃肠动力学影响的基础和临床研究．中国危重病急救医学，1997，9(7)：411-413．
21 赵祥文．胃肠道功能衰竭．急诊医学，1998，7(1)：66-67．
22 amborová P, Hubkal P, Ulková I, et al. The pacemaker activity of interstitial cells of Cajal and gastric electrical activity. Physiol Res, 2003, 52: 275-284.
23 Mintehev MP, Bowes KL. Comparative quantification of gastric electrical activity and electrogastrograms. Med Bio Eng Comput, 1998, 36: 96-100.
24 Chen JD, Richards RD, McCallum RW, et al. Frequency components of the electrogastrograms and their correlations with gastrointestinal motility. Med Biol Eng Comput, 1993, 31: 60-67.
25 Semmlow JL, Orland PJ, Reddell Mr, et al. Evalution of quantitative approaches to asssessment of bowel viability. Biomed Instrum Technol, 1997, 31(6): 591.
26 王晓梅，董云．多器官功能障碍综合征与胃肠道的关系．中国急救医学，2003，23(5)：324-325．
27 Moncada S, Palmer RM, Higgs EA. Nitric oxide: physiology, pathophysiology and pharmacology. Pharmacol Rev, 1991, 43: 109-142.
28 Weitzberg E, Lundberg JM, Rudehill A. Elevated plasma levels of endothelin in patients with sepsis syndrome. Circ Shock, 1991, 33: 222-227.
29 Aneman A, Bengtsson J, Snygg J, et al. Differentiation of the peptidergic vasoregulatory response to standardized splanchnic hypoperfusion by acute hypovolaemia or sepsis in anaesthetized pigs. Acta Physiol Scand, 1999, 166:293-300.
30 Broner C, O'Doriso MS, Rosenberg RB, et al. Cyclic nucleotides and vasoactive intestinal peptide production in a rabbit model of Escherichia coli septicemia. Am J Med Sci, 1995, 309: 267-277.
31 解基良，张志尧，吴咸中．承气方剂对胃肠屏障功能保护作用的实验研究．中国中西医结合外科杂志，2002，8(3)：189-191．
32 Sanders KM. A case for interstitial cells of Cajal as pacemakers and mediators of neurotransmission in the gastrointestinal tract. Gastroenterology, 1996, 111 (2): 492-515.
33 Suzuki N, Prosser CL, Dahns V. Boundary cells between longitudinal and circular layers: essential for electrical slow waves in cat intestine. Am J Physiol, 1986, 250: G287-G294.
34 Basaran UN, Celayir S, Eray N, et al. The effect of an H2-receotor antagonist on small-bowel colonization and bacterial translocation in new born rats. Pediatr Surg Int, 1998, 13: 118-120.
35 Doig CJ, Sutherland LR, Sandham JD, et al. Increased intestinal permeability is associated with the development of multiple organ dysfunction syndrome in critically ill ICU patients. Am J Resptr Crit Care Med, 1998, 158: 444-451.
36 李建生，程龙．中医药对肠道细菌易位作用的研究进展．中西医结合实用临床急救，1999，6(6)：286-288．
37 顾群．对多脏器功能失常综合征中医辨证施治作用机制的认识．河北中医，2002，24(4)：279-281．
38 薛洁，杜鹏，李广学，等．肠气通颗粒对动物胃肠功能的影响．新疆医科大学学报，2001，24(4)：351-353．
39 姬志伟，罗连城，何清宇，等．大承气冲剂对腹腔感染家兔肠运动功能的影响．中国中西医结合外科杂志，1998，4：142-146．
40 刘竞，崔乃强，赵琪，等．通里攻下法对腹膜炎大鼠脏器组织中PGFla／T×B2的影响．中国中西医结合外科杂志，1998，4：76-78．
41 陈海龙，吴咸中，关凤林，等．中医通理攻下法对多器官功能不全综合征时胃肠道屏障功能保护作用的实验研究．中国中西医结合杂志，2000，20(2)：120-122．
42 武若君，李秦，刘京涛，等．大承气汤灌肠在多器官功能障碍综合征中的临床应用．中国现代医学杂志，2003，13(2)：76-77．
43 吴承堂，黎沾良，熊德鑫．中药清胰汤治疗急性坏死性胰腺炎的实验研究．中国中西医结合杂志，1998，18(4)：236-238．
44 Rowlands BJ, Gardiner KR. Nutritional modulation of gut inflammation. Proc Nutr Soc, 1998, 57(3): 395-401.
45 李永渝，魏玉，李莉娟，等．藿香、大黄等CCB中药影响胃肠运动功能的机制探讨．中国中西医结合外科杂志，1997，3：187-190．
46 陈晓理，冉瑞图．大黄治疗坏死性胰腺炎的机理探讨．华西医科大学学报，1996，27(4)：418-421．
47 杨文修．大承气汤和大黄对豚鼠结肠平滑肌细胞电活动的影响．中西医结合杂志，1993，10(1)：82-83．
48 刘汶，张大炜．中药对胃肠运动功能的影响．中国中西医结合脾胃杂志，1998，6：192．
49 黄子荷，杨德治，魏义全，等．阿托品对枳实增强大小肠电活动效应的影响．中国中西医结合杂志，1996，16(5)；292-294．
50 李岩，陈苏宁，李宇权，等．芍甘汤、四逆散对胃排空及小肠推进功能影响的拆方研究．中华消化杂志，1996，16：18-21．
2 崔克亮，曹书华，王今达．大承气汤对多器官功能障碍综合征防治作用的临床研究．中国中西医结合急救杂志，2003，10(1)：12-15．
3 李伟，齐清会，雷少鸣．中药抗炎灵对腹部外科多器官功能障碍综合征患者胃肠激素改变的影响．中国中西医结合急救杂志，2003，10(1)：19-21．
4 Hasssoun HT, Kone BC, Mercer DW, et al. Post-injury multiple organ failure: the role of the gut. Shock, 2001, 15(1): 1-10.
5 Moore FA. The role of the gastrointestinal tract in post injury multiple organ failure. Am J Surg, I999, 178(6): 449-453.
6 陈德昌，杨兴易，景炳文，等．大黄对多器官功能障碍综合征治疗作用的临床研究．中国中西医结合急救杂志，2002，9(1)：6-8．
7 武若君，李秦，刘京涛，等．大承气汤灌肠在多器官功能障碍综合征中的临床应用．中国现代医学杂志，2003，13(2)：76-77．
8 Rombeau JL, Takala J. Summary of round table conference: gut dysfunction in critical illness. Intens Care Med, 1997, 23: 476-486.
9 Beal AL, Cerra FB. Multiple organ failure in the1990s: systemic inflammatory response and organ dysfunction. JAMA, 1994, 271: 226-233.
10 Gennart R, Alexander JM. Effects of hyperoxia on bacteria translocation and mortality during gut derived sepsis. Arch Surg, 1996, 131: 57-62.
11 王鹏巨，吴勤，余开远，等．多脏器功能障碍综合征发病过程的临床研究．中国危重病急救医学，1999，1(1)：491-493．
12 高士杰，刘峰，王继文等．大黄对创伤性休克患者胃肠功能障碍及多器官功能不全综合征的治疗作用．中华创伤杂志，2002，19(10)：586-588．
13 陈德昌，景炳文，杨建东，等．大黄对胃肠动力学影响的基础和临床研究．中国危重病急救医学，1997，9(7)：411-413．
14 屠伟峰，肖光夏．胃肠功能障碍的研究现状．消化外科，2002，1(1)：66-69．
15 牟宜坤，李玛琳，杨为民．大黄对胃肠道作用及其机制探讨．医学综述，2003，9(2)：125-126．
16 Gareth Ackland, Michael PW Grocott, Michael G Mythen. Understanding gastrointestinal perfusion in critical care: so near, and yet so far. Crit Care 2000, 4: 269-281
17 Nieuwenhuijzen GAP, Deitch EA, Gorsi RJA. The relationship between gut - derived bacteria and the development of the multiple organ dysfunction syndrome. J Anat, 1996, 189: 537-548.
18 刘峰，高士杰，胡慧刚，等．大黄治疗休克后胃肠功能障碍的临床研究．中国急救医学，2003，23(1)：38-39．
19 Billiar TR. Nitric oxide. Novel biology with clinical relevance. Ann Surg, 1995,221(4): 339-349.
20 陈德昌，景炳文，杨建东，等．大黄对胃肠动力学影响的基础和临床研究．中国危重病急救医学，1997，9(7)：411-413．
21 赵祥文．胃肠道功能衰竭．急诊医学，1998，7(1)：66-67．
22 amborová P, Hubkal P, Ulková I, et al. The pacemaker activity of interstitial cells of Cajal and gastric electrical activity. Physiol Res, 2003, 52: 275-284.
23 Mintehev MP, Bowes KL. Comparative quantification of gastric electrical activity and electrogastrograms. Med Bio Eng Comput, 1998, 36: 96-100.
24 Chen JD, Richards RD, McCallum RW, et al. Frequency components of the electrogastrograms and their correlations with gastrointestinal motility. Med Biol Eng Comput, 1993, 31: 60-67.
25 Semmlow JL, Orland PJ, Reddell Mr, et al. Evalution of quantitative approaches to asssessment of bowel viability. Biomed Instrum Technol, 1997, 31(6): 591.
26 王晓梅，董云．多器官功能障碍综合征与胃肠道的关系．中国急救医学，2003，23(5)：324-325．
27 Moncada S, Palmer RM, Higgs EA. Nitric oxide: physiology, pathophysiology and pharmacology. Pharmacol Rev, 1991, 43: 109-142.
28 Weitzberg E, Lundberg JM, Rudehill A. Elevated plasma levels of endothelin in patients with sepsis syndrome. Circ Shock, 1991, 33: 222-227.
29 Aneman A, Bengtsson J, Snygg J, et al. Differentiation of the peptidergic vasoregulatory response to standardized splanchnic hypoperfusion by acute hypovolaemia or sepsis in anaesthetized pigs. Acta Physiol Scand, 1999, 166:293-300.
30 Broner C, O'Doriso MS, Rosenberg RB, et al. Cyclic nucleotides and vasoactive intestinal peptide production in a rabbit model of Escherichia coli septicemia. Am J Med Sci, 1995, 309: 267-277.
31 解基良，张志尧，吴咸中．承气方剂对胃肠屏障功能保护作用的实验研究．中国中西医结合外科杂志，2002，8(3)：189-191．
32 Sanders KM. A case for interstitial cells of Cajal as pacemakers and mediators of neurotransmission in the gastrointestinal tract. Gastroenterology, 1996, 111 (2): 492-515.
33 Suzuki N, Prosser CL, Dahns V. Boundary cells between longitudinal and circular layers: essential for electrical slow waves in cat intestine. Am J Physiol, 1986, 250: G287-G294.
34 Basaran UN, Celayir S, Eray N, et al. The effect of an H2-receotor antagonist on small-bowel colonization and bacterial translocation in new born rats. Pediatr Surg Int, 1998, 13: 118-120.
35 Doig CJ, Sutherland LR, Sandham JD, et al. Increased intestinal permeability is associated with the development of multiple organ dysfunction syndrome in critically ill ICU patients. Am J Resptr Crit Care Med, 1998, 158: 444-451.
36 李建生，程龙．中医药对肠道细菌易位作用的研究进展．中西医结合实用临床急救，1999，6(6)：286-288．
37 顾群．对多脏器功能失常综合征中医辨证施治作用机制的认识．河北中医，2002，24(4)：279-281．
38 薛洁，杜鹏，李广学，等．肠气通颗粒对动物胃肠功能的影响．新疆医科大学学报，2001，24(4)：351-353．
39 姬志伟，罗连城，何清宇，等．大承气冲剂对腹腔感染家兔肠运动功能的影响．中国中西医结合外科杂志，1998，4：142-146．
40 刘竞，崔乃强，赵琪，等．通里攻下法对腹膜炎大鼠脏器组织中PGFla／T×B2的影响．中国中西医结合外科杂志，1998，4：76-78．
41 陈海龙，吴咸中，关凤林，等．中医通理攻下法对多器官功能不全综合征时胃肠道屏障功能保护作用的实验研究．中国中西医结合杂志，2000，20(2)：120-122．
42 武若君，李秦，刘京涛，等．大承气汤灌肠在多器官功能障碍综合征中的临床应用．中国现代医学杂志，2003，13(2)：76-77．
43 吴承堂，黎沾良，熊德鑫．中药清胰汤治疗急性坏死性胰腺炎的实验研究．中国中西医结合杂志，1998，18(4)：236-238．
44 Rowlands BJ, Gardiner KR. Nutritional modulation of gut inflammation. Proc Nutr Soc, 1998, 57(3): 395-401.
45 李永渝，魏玉，李莉娟，等．藿香、大黄等CCB中药影响胃肠运动功能的机制探讨．中国中西医结合外科杂志，1997，3：187-190．
46 陈晓理，冉瑞图．大黄治疗坏死性胰腺炎的机理探讨．华西医科大学学报，1996，27(4)：418-421．
47 杨文修．大承气汤和大黄对豚鼠结肠平滑肌细胞电活动的影响．中西医结合杂志，1993，10(1)：82-83．
48 刘汶，张大炜．中药对胃肠运动功能的影响．中国中西医结合脾胃杂志，1998，6：192．
49 黄子荷，杨德治，魏义全，等．阿托品对枳实增强大小肠电活动效应的影响．中国中西医结合杂志，1996，16(5)；292-294．
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