吗啡和纳洛酮对酸化十二指肠引起狗胰液分泌的影响

本工作用制备 Thomas 胰瘘和胃痿的5条狗进行慢性实验。实验时用0.1N 盐酸灌入十二指肠以刺激胰液分泌,并分別注射吗啡或/和纳洛酮,观察它们对胰液分泌和对胰液中碳酸氢盐和蛋白质浓度的影响。另外我们还观察了吗啡和纳洛酮对6条狗离体胰主导管紧张性的影响。结果表明:(1)吗啡抑制了胰液分泌量,对胰液中碳酸氢盐和蛋白质浓度无影响,由于分泌量减少故两者的排出量显著减少(P<0.05),(2)纳洛酮本身对胰液分泌量和碳酸氢盐及蛋白质浓度均无影响;(3)纳洛酮可以加强吗啡抑制胰液分泌的作用(P<0.01);(4)吗啡能增加狗的离体胰主导管肌条的紧张性,纳洛酮不能阻断或翻转吗啡的这一效应,相反能加强其效应。本工作表明,吗啡抑制酸化十二指肠所引起的胰碳酸氢盐和蛋白质排出量,其机制可能是吗啡刺激胰导管收缩,而纳洛酮则加强吗啡的这种抑制效应。     

促胰液素、八肽胆囊收缩素和迷走神经刺激对狗胰液和血清中胰多肽含量的影响

对10只麻醉下主胰管内插置导管的家狗进行急性实验。用放射免疫测定法测定静脉注射促胰液素(8μg/kg)和八肽胆囊收缩素(CCK_8,40ng/kg)以及电刺激胸迷走神经前后的胰液和血清中胰多肽的含量。结果表明,基础胰液中含有大量胰多肽免疫活性物质,平均排出量为3130±2200pg/15min,其平均浓度高于血清水平40倍左右,但是个体之间的变异范围较大。当静脉注射促胰液素和 CCK_8以及电刺激胸迷走神经后,胰液胰多肽排出量和血清胰多肽水平均增多,其中以电刺激迷走神经后尤为明显。高峰都在刺激后15min 内出现。经促胰液素,CCK_8和迷走神经刺激后,胰液中胰多肽排出量比刺激前分别增加105%,52%和200%。外源性促胰液素或 CCK_8刺激后,胰液中胰多肽与 HCO_3~-出量之间或胰液中胰多肽与淀粉酶排出量之间,分别均呈一致的关系。本文结果提示,胰多肽不仅是一种内分泌,它亦具有外分泌的特性。迷走神经、促胰液素和胆囊收缩素对胰多肽的释放具有调节作用。     

牛胰多肽对大鼠胰外分泌的抑制作用

在大鼠观察了牛胰多肽(BPP)对由蛋白胨和雨蛙素引起的大鼠胰外分泌的影响。向十二指肠灌入25%蛋白胨后90min 时,对照组的蛋白排出量约为其基础值的10倍,而1、3、5及10ug/kg BPP 剂量组的蛋白排出量分別为对照组的47%、33%、29%及29%。在灌注剂量为3μg/kg 雨蛙素后60min 时,对照组的蛋白排出量约为其基础值的14倍,但3、5及10μg/kgBPP 剂量组的蛋白排出量分別为对照组的74%、68%及55%。各组胰淀粉酶浓度的变化和其蛋白排出量变化相平行。胰液量的增加不受 BPP 影响。结果提示,BPP 能抑制胰酶的大量分泌,并有剂量依从关系,但不抑制胰液量。     

氯丙嗪对狗胰液分泌的影响

本工作在6只Соловьθв胰瘘狗(其中3只同时带有巴索夫胃瘘)上进行,向十二指肠肠腔内重复注入稀盐酸引起胰液分泌,一共作了78次实验,其主要结果如下:(一)在正常以及颈部迷走封闭与膈上迷走切断的情况下,肠内重复注酸后胰液分泌量一直维持在一个一定高度的水平;脂肪酶与胰蛋白酶活性的变化进程呈现平行关系。(二)在上述三种情况下,静脉注入氯丙嗪(1毫克/公斤)都大幅度地降低胰液分泌量达两小时以上;同时,脂肪酶与胰蛋白酶活性的平行关系发生紊乱。由此说明氯丙嗪对胰腺液体的分泌具有抑制作用,对胰酶活性的平行变化有分离作用,而且不是以迷走神经为其作用的传出途径。(三)文中讨论了氯丙嗪作用的可能机制。     

对牛胰多肽抑制胰酶分泌作用的离体研究

为探讨胰多肽抑制胰酶分泌的机制,我们利用大鼠离体胰腺泡制备观察了牛胰多肽(BPP)在细胞受体水平对氨甲酰胆碱等促分泌物作用的影响。实验结果显示,BPP 对氨甲酰胆碱诱导的胰腺泡淀粉酶分泌具有抑制作用,并存在剂量反应关系。BPP0.1μmol/L 和0.2μmol/L,可分别使氨甲酰胆碱诱导淀粉酶分泌的效价降低3倍和10倍;BPP 还可抑制氨甲酰胆碱刺激胰腺泡释放~(45)Ca。以上结果提示,BPP 对胰腺泡的胆碱能 M 受体具有拮抗作用。此外,BPP 对促胰液素及其同类激动剂和氨甲酰胆碱协同作用诱导的胰腺泡淀粉酶分泌具有抑制作用,提示胰多肽在整体对促胰液素诱导的胰酶分泌的抑制,可能是通过拮抗胰腺泡细胞上的 M 受体而抑制了促胰液素和胆碱能刺激协同作用引起的胰酶分泌。     

胰瘘发生假说到捆绑式胰肠吻合的临床运用

为避免术后胰瘘的发生,在过去的100年间提出了多种胰肠吻合重建方式,但哪种方法最好一直备受争议.胰肠吻合后吻合针距间存在可能的间隙,这个问题或许成为胰肠吻合口瘘的爆发点,而且存在贯穿浆肌层缝合的胰腺表面外露的吻合针眼,如果缝针贯穿胰管小分支,胰液可能从针眼流出.这一假说构成了捆绑式胰肠吻合的基础.捆绑式胰肠吻合是一种安全、有效的预防术后胰瘘的吻合方式.     

神經与激素因素在胰液分泌調节中的相互关系

本实验系用狗为对象,分慢性和急性实验两种,但实验均在戊皖巴比妥钠的麻醉下进行。我们观察了神经与激素二因素,于不同的结合方式的情况下,对胰液分泌调节中的相互关系,结果证明: (一)在激素刺激(注促胰液素入静脉或注盐酸入小肠)对胰腺的效应停止后的10分钾内,紧接着刺激切断4—6天后的颈部迷走神经离中端,所引起的胰液分泌,较单独刺激同一神经时所引起的胰液分泌量多,潜伏期短, (二)神经与激素二因素同时作用,所引起的胰液分泌量,大大超过此二因素分别作用所得的效应的总和。 (三)在激素对胰腺的刺激效应停止后的10分钟内,紧接着注射毛果芸香硷,所引起的胰液分泌量,较单独注射毛果芸香碱为多。根据以上结果可以认为:神经与激素二因素在胰液分泌调节中有相互加强的作用。     

八种脑-肠肽侧脑室内注射对大鼠基础胃酸分泌的影响

用乌拉坦麻醉大鼠作急性实验,采用连续灌流胃并收集流出液的方法,观察向侧脑室内注射微量脑-肠肽对大鼠基础胃酸分泌的影响。实验结果如下:(1)雨蛙肽、八肽胆囊收缩素、促甲状腺素释放激素及四肽胃泌素均使总酸排出量增加;(2)生长抑素、胰多肽、P 物质、胰高血糖素则使总酸排出量减少;(3)上述肽类用侧脑室注射的剂量作肌肉注射,除四肽胃泌素也产生明显的刺激胃酸分泌作用外,对胃酸分泌均无明显影响。以上结果提示,脑内的一些肽类可能以神经递质或调制物的方式,参与中枢对胃酸分泌的调节。     

迷走-胃泌素机制在胃液分泌神經反射期中的重要性

本工作利用具有食道瘘和新设计的胃肠四通瘘的狗进行慢性实验,以收集完整神经支配的全部胃底和胃体部的胃液分泌,观察切除胃窦前后假饲和胰岛素低血糖刺激所引起的胃酸分泌的变化,企图阐明迷走-胃泌素机制在胃液分泌神经反射期中的重要性,结果如下: (一)切除胃窦后,由于取消了迷走-胃泌素的作用,胃腺对假饲及胰岛素低血糖所引起的3.5小时总酸排出量分别较切窦前减少了86.6％及80.6％。 (二)给切除胃窦后的狗皮下注射一定量的胃泌素并与假饲同时作用,使其总酸排出量基本上恢复至切除胃窦前假饲的水平,然后分别测定单独假饲及单独注射该剂量胃泌素时的总酸排出量。结果指出,单独假饲与单独注射胃泌素的作用比例约为1∶4。这表明在胃液分泌神经反射期中迷走-胃泌素作用较迷走直接作用为强。 (三)注射胃泌素与假饲同时作用所引起的总酸排出量较两者单独作用时所引起的总酸排出量之机械总和高出约一倍。这表明迷走直接作用与迷走-胃泌素作用之间有相互加强效应。总结以上结果,可以认为:在胃液分泌的神经反射期中,确实存在有迷走直接作用和迷走-胃泌素作用两种机制,后者起着重要作用,而二者又有相互加强效应。     

血糖浓度对糖尿病大鼠胰腺外分泌功能的影响

用链佐霉素诱导大鼠产生尿病,其胰腺组织淀粉的含量降低,胆囊收缩素（ＣＣＫ－８）刺激所引起的胰淀粉酶分泌也明显降低。用一种可以降低糖尿病大鼠血糖,但不影响其血清胰岛素水平的药物－－钒酸钠灌胃,可翻转上述变化。体外实验分析表明,高糖可抑制胰腺泡蛋白质的合成,还可以引起胰腺泡膜丙二醛含量增加,从而提示,糖尿病大鼠胰外分泌功能障碍与血液葡萄浓度过高有密切关系。     

Lack of CCK-like pancreatic stimulation by intraduodenal amino acids in the anesthetized cat

We have attempted to demonstrate a pancreatic secretory response to intraduodenal amino acids in the anesthetized cat. In four cats stimulated with supramaximal doses of secretin, protein concentrations in pancreatic juice were measured after intraduodenal bolus injection of various amino acids, IV CCK, or electrical stimulation of the vagus nerve. In addition, the duodenum was perfused with phenylalanine (50 mM) for 30 min in two cats, and the vagus nerve stimulated electrically for 15 min in one. In no case did amino acids produce pancreatic protein secretion, whereas CCK and vagal stimulation always did so. We conclude that this insensitivity to amino acids in the cat is a species difference from the dog and man.     

CCK and PYY do not participate in the delayed inhibition of pancreatic secretion, after stimulation by duodenal oleic acid infusion.

The role played by CCK in the stimulation of pancreatic secretion by duodenal infusion of oleic acid in conscious rats was studied using a potent and specific CCK receptor antagonist. CR-1409 did not alter basal secretion, which does not require CCK. The three doses of CR-1409 that were used (2, 4 and 8 mg/kg/h) suppressed the protein response to duodenal infusion of oleic acid and significantly enhanced the delayed inhibition normally observed in control rats (-81%, -87% and -88% vs. -51% of basal in controls). CR-1409 dose-dependently reduced the volume of pancreatic secretion after duodenal infusion of oleic acid (0.40 +/- 0.02, 0.36 +/- 0.02, 0.34 +/- 0.03 vs. 0.48 +/- 0.04 ml/30 min for 2, 4, 8 mg/kg/h and controls, respectively) and revealed a delayed inhibition of volume and a slight reduction of bicarbonate secretion. CCK appears to be directly responsible for the protein and also water response to duodenal infusion of oleic acid, and to be indirectly involved in bicarbonate stimulation. PYY antiserum significantly augmented protein output after duodenal infusion of oleic acid (10.75 +/- 1.40, 14.10 +/- 1.60 vs. 8.60 +/- 1.20 mg/30 min, 1 microliter, 2 microliters and controls), but failed to modify the delayed inhibition: PYY modulates the response to duodenal infusion of oleic acid and is not involved in the delayed inhibition, which was shown to be also present for volume, but which is normally masked by the action of CCK.     

Effect of somatostatin on exocrine pancreatic secretion stimulated by pancreozymin-secretin or by a test meal in the dog

In 4 dogs with chronic duodenal and gastric fistulae, exocrine pancreatic function was assessed by cannulating the pancreatic duct and collecting the duodenal contents. Both methods were applied in each animal. Pancreatic secretion was stimulated by infusion of 2 CHR units of pancreozymin and secretin or by administration of a liquid test meal, injected into the stomach through the gastric fistula. During both experiments 3.5 microgram/kg somatostatin was given as bolus injection followed by an infusion of 3.5 microgram/kg/h. Somatostatin caused a significant reduction in protein and amylase output and in the bicarbonate concentration during stimulation with pancreozymin-secretin. Volume and bicarbonate slightly decreased but not to a significant extent. Duodenal volume and the duodenal activities of trypsin and amylase were significantly reduced during test meal stimulation and somatostatin infusion. Somatostatin is a potent inhibitor of exocrine pancreatic function mainly influencing enzyme secretion.     

Canine vagus nerve stores cholecystokinin-58 and -8 but releases only cholecystokinin-8 upon electrical vagal stimulation

Cholecystokinin-58 has been shown to be the major form of cholecystokinin (CCK) released to the circulation upon lumenal stimulation of the small intestine in humans and dogs. In anesthetized dogs, electrical vagal stimulation evokes pancreatic exocrine secretion that is in part mediated through the release of CCK. We studied the molecular form of CCK stored in canine vagus nerves and that released into circulation upon electrical vagal stimulation. Gel filtration and radioimmunoassay of the water and acid extracts of canine vagus nerves indicated CCK-8 (35%) and CCK-58 (65%) as the major molecular forms in the vagus nerve. Both forms of CCK isolated from the vagal extracts were equally bioactive as the standard CCK-8 and CCK-58, respectively, in stimulation of amylase release from isolated rat pancreatic acini. Analysis of plasma collected after electrical vagal stimulation indicated that CCK-8 is the only form released into the circulation. The release of CCK-8 upon electrical vagal stimulation was not affected by application of lidocaine to the upper small intestinal mucosa, suggesting that it was released from vagal nerve terminals.     

Vasoactive intestinal polypeptide (VIP) in the pig pancreas: role of VIPergic nerves in control of fluid and bicarbonate secretion

Vasoactive intestinal polypeptide (VIP) in the pig pancreas is localized to nerves, many of which travel along the pancreatic ducts. VIP stimulates pancreatic fluid and bicarbonate secretion like secretin. Electrical vagal stimulation in the pig causes an atropine-resistant profuse secretion of bicarbonate-rich pancreatic juice. In an isolated perfused preparation of the pig pancreas with intact vagal nerve supply, electrical vagal stimulation caused an atropine-resistant release of VIP, which accurately parallelled the exocrine secretion of juice and bicarbonate. Perfusion of the pancreas with a potent VIP-antiserum inhibited the effect of vagal stimulation on the exocrine secretion. It is concluded, that VIP is responsible for (at least part of) the neurally controlled fluid and bicarbonate secretion from the pig pancreas.     

Comparison of enkephalin and atropine in the inhibition of vagally stimulated gastric and pancreatic secretion and gastrin and pancreatic polypeptide release in dogs

Enkephalins have been detected in vagal nerves and myenteric plexus neurons but no study has been performed to determine their action on vagally stimulated gastric and pancreatic secretion. In this study we infused IV methionine-enkephalin (Met-enk) alone, naloxone (a pure opiate antagonist) alone, or their combination before, during and after vagal stimulation in 4 dogs with esophageal, gastric and pancreatic fistulas. For the comparison, atropine was given before, during and after vagal stimulation in the same animals. Vagal stimulation was obtained by 15 min sham-feeding, which produced an increase in gastric H⁺ output to a peak of about 75% of the maximal response to pentagastrin and pancreatic protein secretion amounting to about 71% of the maximal response to caerulein. It was accompanied by a significant rise in serum gastrin and pancreatic polypeptide (PP) levels. Met-enk inhibited significantly both gastric H⁺ and pancreatic protein secretion and reduced plasma PP but not gastrin levels. Similar effects were obtained after the administration of atropine. The effects of Met-enk were partly reversed by the addition of naloxone. We conclude that (1) enkephalin suppresses vagally stimulated gastric and pancreatic secretion and plasma PP release; (2) these secretory effects of enkephalin seem to be mediated by opiate receptors and could be explained by its inhibitory action on acetylcholine release (“anticholinergic” action) in the stomach and the pancreas.     

消化管括约肌部VIP免疫活性神经细胞分布

应用免疫组织化学方法研究了食管下部,幽门和回盲部肌间神经丛内ＶＩＰ免疫活性神经细胞的分布。ＶＩＰ免疫活性神经细胞在括约肌部比相邻部位数量多。并用Ｏｐｅｎ－ｔｉＰ法测量了刺激迷走神经后食管下段括约肌部压力的变化。用高阈值参数电刺激迷走神经引起预先投给阿托品的狗食管下段括约肌部压力的降低;这样条件下延长迷走神经刺激引起肌间神经丛内ＶＩＰ免疫活性神经细胞数量明显增加。由此结果提示含有或产生ＶＩＰ的神经细胞可能接受迷走神经的控制。由于刺激节前迷走神经纤维可能作用到这些细胞。     

Potentiation of cholecystokinin-induced exocrine secretion by either electrical stimulation of the vagus nerve or exogenous VIP administration in the guinea pig pancreas

In the anaesthetized guinea pig, the secretory responses (pancreatic juice flow and protein output) induced by electrical stimulation of the vagus nerve were not blocked by atropine but by hexamethonium. Excitation of the left vagus nerve induced by electrical stimulation significantly potentiated the C-terminal octapeptide of cholecystokinin (CCK-OP)-induced secretory responses. In the isolated perfused pancreas of guinea pig, the secretory responses induced by CCK-OP at concentrations in the physiological range were markedly potentiated by simultaneous stimulation with vasoactive intestinal peptide (VIP). However, the secretory responses induced by CCK-OP at higher concentrations were not potentiated but inhibited by simultaneous stimulation of VIP. The secretory responses induced by carbachol (CCh) at any concentrations were not potentiated but inhibited by simultaneous stimulation of VIP. These results support the view that VIP released from the nerve endings can potentiate the hormonal action of CCK-OP.     

刺激家兔腹部迷走神经外周端引起的降压作用

本文对电刺激家兔腹部的迷走神经外周端所引起的降压反应进行了研究。在121只家兔中的实验结果表明:电刺激腹部迷走神经外周端可引起动脉压、小肠和后肢的灌流压同时降低,而心率则无明显变化。这一降压反应发生时,小肠静脉血中的组织胺含量较刺激前明显升高,然后恢复;将小剂量的组织胺 H_1受体阻断剂扑尔敏、非乃根和 H_2受体阻断剂甲氰咪胍(Cimetidine)分别注入肠系膜上动脉均能减弱刺激腹部迷走神经外周端引起的动脉压和小肠灌流压的降低。心得安能削弱此降压反应,而阿托品无效;切断两侧内脏大神经能显著削弱刺激腹部迷走神经外周端引起的降压反应。此残余的降压反应在注入抗组织胺剂后完全消失。由此推论,刺激家兔腹部迷走神经外周端引起的降压反应是通过中枢和外周两方面因素的作用,使血管舒张,外周阻力降低而实现的。