口服补液减轻40%血容量失血大鼠肠组织缺血性损伤

目的：研究口服葡萄糖-电解质液（GES）对大鼠40%血容量失血时肠组织缺血性损伤的影响。方法：雄性SD大鼠,用氯胺酮-速眠新Ⅱ肌注复合麻醉后,行右颈动脉插管。随机分为3组（n=24）：GES对照组（GES）,失血性休克组（HS）和失血性休克＋口服GES液组（HS＋GES）。GES组：不放血,手术后口服GES;HS和HS＋GES组按全身血容量的40%分两次间隔15min放血制作失血性休克模型。HS＋GES组于失血后0.5h、1h和6h分3次给予3倍失血量的GES灌胃。用激光多谱勒血流仪测定失血后2h、4h和24h肠组织血流量（IBF）后,处死动物后取肠组织检测二胺氧化酶（DAO）和Na^＋-K^＋-ATP酶活性,测定肠组织含水率（WG）,并做病理学检查。结果：HS＋GES组IBF和Na-K-ATP酶活性均显著高于HS组（P〈0.05）,但显著低于GES组（P〈0.05）;失血各组肠WG显著高于GES组（P〈0.05）,24h时HS＋GES组WG显著低于HS组（P〈0.05）;HS＋GES组24hDAO活性均显著高于HS组（P〈0.05）,但显著低于GES组（P〈0.05）;失血后24h病理检查HS＋GES组肠组织水肿和充血改变比HS组明显减轻。结论：口服GES液能显著增加大鼠失血性休克早期IBF,提高Na^＋-K^＋-ATP酶和DAO活性,减轻肠组织水肿和缺血性损伤。     

新型淀粉纳米囊人工红细胞有效性初步研究

目的:采用季铵盐阳离子淀粉为囊材包裹牛血红蛋白,制备成纳米级的新型季铵盐阳离子淀粉人工红细胞(Nanosized Cationic Amylose-encapsulated Hemoglobins,NCAHbs)并评价此新型人工红细胞的有效性.方法:应用大鼠重度失血性休克模型,将50只健康SD大鼠随机分成5组:休克对照组(Control组,n=10)、淀粉纳米囊人工红细胞组(NCAHbs组,n=10)、Ringer乳酸盐溶液组(Ringer's组,n=10)、羟乙基淀粉组(HES组,n=10)和全血组(Blood组,n=10);动态监测平均动脉血压(MAP),于休克前(T0)、休克末(T1)及复苏后1 h(T2)测定动脉血气指标,并记录24h内大鼠的存活情况.结果:Ringer's组、HES组复苏后大鼠MAP仍较低,NCAHbs组复苏后MAP接近Blood组,并能有效维持;复苏后1h,Blood组和NCAHbs组PCO2、PO2均得到改善,接近休克前基础水平;仅NCAHbs组及Blood组术后24h生存率为100％.结论:新型淀粉纳米囊人工红细胞能够有效的扩容、携氧,明显改善重度失血性休克时机体和组织的氧供,是较为理想的人工氧载体.     

牛磺酸对失血性休克复苏家兔血浆和心肌NOS活性影响

目的:探讨牛磺酸对失血性休克复苏后血浆和心肌一氧化氮合酶(NOS)活性、一氧化氮(NO)含量变化的影响.方法:新西兰种兔24只随机分为3组(n=8):对照组、休克组、牛磺酸治疗组.采用失血性休克复苏动物模型.连续观察休克前、休克1.5 h、复苏后1 h、2 h、3 h血浆一氧化氮合酶(NOS)活性、一氧化氮代谢产物(NO-2/NO-3)含量、乳酸脱氢酶(LDH)活性的动态变化.测定复苏后3 h心肌一氧化氮合酶(NOS)活性、一氧化氮代谢产物(NO-2/NO-3)含量的变化,并常规留取心肌标本观察形态学改变.结果:①休克组复苏后各时限血浆NOS活性、NO-2/NO-3含量、LDH活性显著高于休克前及休克1.5 h;②休克组复苏后3 h心肌NOS活性、NO-2/NO-3含量显著高于对照组,心肌出现明显水肿和脂肪变性;③牛磺酸(40 mg·kg-1 iv)可显著缓解上述变化.结论:失血性休克复苏后NOS的激活和NO的大量释放,可能介导了休克复苏所致心肌损伤,牛磺酸可减少NO的生成使心肌损伤减轻.     

失血性休克复苏后肠内给予特殊营养物对肠粘膜血流量的影响

为探讨失血性休克复苏后肠内营养与肠粘膜血流改变的关系 ,从SD大鼠开腹制作空肠袋 ,将激光多谱勒探头和肠粘膜张力计放置在空肠袋两端 ,根据动物分组分别向袋内注射葡萄糖、谷氨酰胺、丙氨酸及甘露醇。复制失血性休克模型 (30mmHg ,维持 6 0min) ,然后用林格氏液复苏 ,恢复灌流 6 0min。分别测定肠粘膜血流量和局部PCO2 张力 (PrCO2 )。结果显示 ,失血性休克和复苏过程中 ,谷氨酰胺和葡萄糖组粘膜血流量比甘露醇和丙氨酸组显著增加 ,PrCO2 显著降低 ;而肠内给予丙氨酸进一步降低肠粘膜血流量 ,升高PrCO2 。提示 :失血性休克复苏后 ,肠内给予丙氨酸减少肠粘膜血流量 ;而给予谷氨酰胺和葡萄糖能增加肠粘膜血流量 ,对缺血再灌流损伤的肠道提供保护作用     

外源性硫化氢对创伤失血性休克大鼠血浆炎症因子的影响

目的：研究外源性硫化氢（H2S）对创伤失血性休克大鼠炎症反应的影响。方法：选择健康成年雄性SD大鼠随机分为四组：假手术组（Sham）,模型组（HTS）,生理盐水组（NS）,NaHS处理组（NaHS）,采用创伤失血性休克模型,Sham组完成所有手术操作,但不放血和复苏,HTS组完成所有手术操作放血后给予Ringer＇s液复苏,NS组放血后在Ringer＇s液复苏前腹腔注射与NaHS组等容量的生理盐水,NaHS组在复苏前给与NaHS28μmol/kg（生理盐水稀释至0.5ml）腹腔注射。持续监测各组平均动脉压（MAP）及心律（HR）,并通过测定血浆中TNF-α、IL-1β、IL-6和IL-10浓度的变化,观察外源性硫化氢对创伤失血性休克大鼠血浆炎症因子的影响。结果：①与HTS组及NS组比较,NaHS组复苏后MAP明显改善（P〈0.05）。②与HTS组及NS组比较,复苏后1小时NaHS组血浆TNFα、IL-1β、IL-6浓度明显降低（P〈0.05）;而IL-10浓度四组间差异不明显（P〉0.05）。结论：外源性硫化氢可改善创伤失血性休克大鼠复苏后平均动脉压及抑制复苏后早期炎症反应。     

限制性液体复苏对多发性骨折合并创伤失血性休克患者凝血功能、心肌损害指标及预后的影响

目的:探讨限制性液体复苏对多发性骨折合并创伤失血性休克患者凝血功能、心肌损害指标及预后的影响。方法:选取我院收治的多发性骨折合并创伤失血性休克患者77例,分为研究组(n=39)、对照组(n=38),对照组给予常规液体复苏,研究组给予限制性液体复苏,比较两组患者凝血功能、心肌损害指标、输液量、失血量、输血量、并发症发生率及病死率。结果:研究组的输液量、失血量、输血量均少于对照组(P0.05)。与复苏前相比,两组患者复苏1 h后凝血酶原时间(PT)、凝血活酶时间(APTT)、凝血酶时间(TT)均延长,且研究组长于对照组(P0.05);两组患者复苏1 h后肌酸激酶(CK)、肌酸激酶-同工酶(CK-MB)、肌钙蛋白T(CTnT)水平均下降,且研究组低于对照组(P0.05)。研究组复苏期间并发症发生率、病死率均低于对照组(P0.05)。结论:限制性液体复苏治疗多发性骨折合并创伤失血性休克患者,可改善患者凝血功能和预后,降低并发症发生率,同时还可减轻心肌损害。     

不同液体复苏对失血性休克大鼠肠粘膜的影响

目的：观察不同液体复苏对失血性休克大鼠肠粘膜的影响以及肠粘膜的变化。方法：利用大鼠失血性休克模型以及不同的补液方式,在复苏后120分钟时处死大鼠,取回肠4cm,做病理切片并根据Chiu等方法评估回肠黏膜上皮损伤指数。结果：液体复苏组的肠粘膜损伤程度小于休克不补液组（p〈0.05）,而限制型液体复苏组的肠粘膜损伤程度小于充分液体复苏组（p〈0.05）。结论：通过本实验对肠粘膜的观察可以得出,对于失血性休克,液体复苏时有效的抗休克方式,而对于复苏的方式来说,从肠黏膜的保护方面来说,限制型液体复苏是优于传统的充分液体复苏的。     

灵光注射液对失血性休克大鼠胃肠粘膜的保护作用

目的　观察灵光注射液 (复方樟柳碱 )对失血性休克再灌注大鼠胃肠粘膜损伤的影响。方法　将 5 6只雄性Wistar大鼠随机分 4组 ,分别设为假休克组 (8只 )、模型组 (16只 )、灵光注射液低剂量组 (16只 )和高剂量组(16只 ) ,除假休克组外 ,大鼠均经历 4kPa ,70min的失血性休克 ,在休克复苏后 6h和 12h各组分别处死半数动物 ,观察大鼠肠道菌移位情况、病理组织学和超微结构变化。结果　灵光注射液对大鼠失血性休克再灌注引起的肠道细菌移位和胃肠粘膜形态损伤有明显的保护作用 ,其治疗机制可能与改善微循环、清除氧自由基作用有关     

灵光注射液对失血性休克大鼠心脏和肝脏的影响

目的　观察灵光注射液 (复方樟柳碱 )对失血性休克再灌注大鼠心脏和肝脏损伤的影响。方法　将5 6只雄性大鼠随机分 4组 ,分别设为假休克组 (8只 )、模型组 (16只 )、灵光注射液低剂量组 (16只 )和高剂量组 (16只 ) ,除假休克组外 ,大鼠均经历 4kPa ,70min的失血性休克 ,在休克复苏后 6h和 12h各组分别处死半数动物 ,检测血清CK、CK MB、LDH、ALT、AST ,心脏和肝脏做组织学和超微结构检查。结果与结论　灵光注射液对大鼠失血性休克再灌注引起的心脏和肝脏功能和形态损伤均有明显的治疗作用 ,其机制可能与改善微循环、清除氧自由基和保护生物膜作用有关。     

外源性硫化氢对创伤失血性休克大鼠血浆炎症因子的影响

目的:研究外源性硫化氢(H2S)对创伤失血性休克大鼠炎症反应的影响。方法:选择健康成年雄性SD大鼠随机分为四组:假手术组(Sham),模型组(HTS),生理盐水组(NS),NaHS处理组(NaHS),采用创伤失血性休克模型,Sham组完成所有手术操作,但不放血和复苏,HTS组完成所有手术操作放血后给予Ringer’s液复苏,NS组放血后在Ringer’s液复苏前腹腔注射与NaHS组等容量的生理盐水,NaHS组在复苏前给与NaHS28μmol/kg(生理盐水稀释至0.5ml)腹腔注射。持续监测各组平均动脉压(MAP)及心律(HR),并通过测定血浆中TNF-α、IL-1β、IL-6和IL-10浓度的变化,观察外源性硫化氢对创伤失血性休克大鼠血浆炎症因子的影响。结果:①与HTS组及NS组比较,NaHS组复苏后MAP明显改善(P<0.05)。②与HTS组及NS组比较,复苏后1小时NaHS组血浆TNFα、IL-1β、IL-6浓度明显降低(P<0.05);而IL-10浓度四组间差异不明显(P>0.05)。结论:外源性硫化氢可改善创伤失血性休克大鼠复苏后平均动脉压及抑制复苏后早期炎症反应。     

表皮生长因子和降钙素基因相关肽在高频电磁场 治疗急性胃损伤中作用研究

目的：探讨高频电磁场（high-frequency electromagnetic fields,HEMFs）曝露治疗急性胃损伤的作用机制。方法：选用健康SD大鼠,以Indomethacin灌胃法复制胃粘膜急性损伤模型,观察40．68MHz HEMFs（波长为7．3m）曝露（微热量,30—50mA,15min,1／d）治疗1或6次后,大鼠胃粘膜损伤程度（胃损伤指数和病理损伤积分）、胃粘膜血流量、血浆表皮生长因子（epidermal growth factor,EGF）和降钙素基因相关肽（calcitonin gene—related peptide,CGRP）水平。结果：HEMFs曝露1次后,胃粘膜血流量较对照组明显升高（P〈0．05）,大鼠胃粘膜损伤程度、血浆EGF和CGRP水平较对照组均无显著性差异（P均〉0．05）;HEMFs曝露6次后,胃粘膜损伤程度较对照组明显改善（P均〈0．05）,胃粘膜血流量显著升高（P〈0．05）,血浆EGF和CGRP水平较对照组无显著性差异（P均〉0.05）。结论：HEMFs曝露治疗大鼠胃粘膜急性损伤可能与其增加胃粘膜血流量有关,与血EGF和CGRP无关。     

Somatostatin-induced gastric protection against ethanol: involvement of nitric oxide and effects on gastric mucosal blood flow

BACKGROUND--AIMS:The mechanisms of somatostatin-mediated gastroprotection are not fully understood. Aims of this study were to determine in the rat the role of nitric oxide (NO) in somatostatin-induced effects on gastric mucosal protection and blood flow (GMBF) in the absence and in the presence of intraluminal ethanol. METHODS: Ethanol (70% v/v)-induced gastric mucosal injury after orogastric dosing was quantitated at 30 min and GMBF determined in an ex vivo gastric chamber preparation. RESULTS: Somatostatin (4 microg/kg; i.p.) protection against ethanol-induced ulceration was prevented by the NO inhibitor L-NNA and restored by L-arginine, but not D-arginine. Somatostatin (1-8 microg/kg; i.p.) did not effect basal GMBF. The gastroprotective dose of somatostatin (4 microg/kg; i.p.) prevented the decrease in GMBF caused by ethanol. L-NNA reversed this vascular effect of somatostatin. CONCLUSION: Somatostatin-induced gastroprotection and restoration of GMBF during ethanol exposure involve mechanisms which are dependent on NO generation.     

Aggravation of ischemia/reperfusion-induced gastric lesions in streptozotocin-diabetic rats

We examined the influence of diabetes on ischemia/reperfusion-induced gastric damage in rats, in relation to the antioxidative system. Animals were injected with streptozotocin (STZ: 70 mg/kg, i.p.) and used after 5 weeks of diabetes with blood glucose levels of >350 mg/dl. Gastric mucosal blood flow (GMBF) was measured before, during and after 20 min of ischemia (1.5 ml bleeding per 100 g body weight from the carotid artery) followed by a 15-min reperfusion in the presence of acid (100 mM HCI). At the end of each experiment, gastric damage was observed macroscopically. GMBF was reduced by ischemia in all groups of rats, followed by a gradual return after reperfusion. Ischemia/reperfusion produced hemorrhagic lesions in normal rat stomachs in the presence of 100 mM HCl. These lesions were significantly aggravated when the animals were pretreated with diethyldithiocarbamate, an inhibitor of superoxide dismutase (SOD). Ischemia/reperfusion-induced damage was also markedly exacerbated in STZ-diabetic rats, but this aggravation was significantly suppressed by pretreatment with exogenous SOD or glutathione (GSH). Diabetic rat stomachs showed significantly less SOD activity as well as GSH content than normal rat stomachs. In addition, the deleterious influence of diabetes on the gastric ulcerogenic response to ischemia/reperfusion was significantly mitigated by decreasing the blood glucose levels by daily insulin treatment. These results suggest that the gastric mucosa of diabetic rats is more vulnerable to ischemia/reperfusion-induced injury, and the mechanism may be partly accounted for by impairment of the antioxidative system associated with a reduced SOD activity and GSH content.     

大鼠急性肾缺血再灌注损伤模型的建立与评估

目的：对现有的经腹部切口建立急性肾缺血再灌注损伤动物模型进行改良,探索建立急性肾缺血再灌注损伤模型的新方法。方法：实验组大鼠16例,经背部切口进入腹膜后间隙,游离钳夹双侧肾动脉45min后开放血流,建立急性肾缺血再灌注损伤模型;伪手术组8例,不夹闭肾动脉,余步骤与实验组相同;对照组8例无处理。术后通过建模成功率、组织病理检查、血肌酐和血尿素氮及氧化应激水平对模型进行评估。结果：实验组15只成功建立急性肾缺血再灌注损伤模型。术后1天病理检查显示实验组肾组织出现广泛损伤,术后实验组’肾小管坏死评分、肾MDA水平、血肌酐及血尿素氮值明显高于对照组（P〈0．05）。结论：经背部切口钳夹双侧肾动脉可建立稳定的大鼠急性肾缺血再灌注损伤模型。该造模方法简便易行,成功率高,且具备手术切口小、手术时间短及并发症少的优点,建立的模型适合于急性肾损伤的研究。     

中药芪莪合剂联合西药治疗幽门螺杆菌诱导的慢性胃炎模型的实验研

目的观察芪莪合剂联合西药对幽门螺杆菌（Hpylori）诱导的慢性胃炎模型的治疗作用,从胃黏膜血流及Cx32、Cx43表达改变探讨其作用机制。方法70只BALB／C小鼠随机分为模型组54只,正常对照组16只。模型组采用东亚型CagA’Hpylori菌株造模,其中48只随机分为4组,分别用芪莪合剂1联合西药组（A组）、芪莪合剂2联合西药组（B组）、三联西药（c组）灌胃治疗14d,对照组用生理盐水（D组）。停用治疗后4周观察Hpylori根除率、胃黏膜炎症改变、胃黏膜血流及Cx32、Cx43表达情况。结果A、B、C组Hpylori根除率分别为83．3％、91．6％与75．0％,胃黏膜炎症评分A、B组与c组均低于D组（P〈0．05）,且A、B组均低于C组（P〈0．05）。A、B组胃黏膜血流量均增加,高于C组和D组,与正常对照组比较差异无统计学意义,A、B、C组Cx32、Cx43mRNA表达均明显高于D组（P〈0．05）,与正常对照组比较差异无统计学意义。结论芪莪合剂与西药合用在减小西药剂量的情况下仍能有效根除Hpylori,且提高胃黏膜血流量,改善胃黏膜炎症,上调Cx32、Cx43mRNA表达。     

C型钠尿肽及其受体在急性肺损伤大鼠肺组织的表达变化及其意义

目的了解C型钠尿肽及其受体NPRB在急性肺损伤大鼠肺组织中的表达变化规律。方法采用LPS注射建立ALI大鼠动物模型。将动物分为生理盐水组(N组),LPS干预1 h组(LPS 1 h组),LPS干预3 h组(LPS 3 h组),LPS干预6 h组(LPS 6 h组),通过RT-PCR检测各组大鼠肺组织CNP及NPRB mRNA的表达情况,以及免疫组化检测各组大鼠NPRB的表达变化,以生理盐水组作为阴性对照。结果正常大鼠肺组织可表达CNP及NPRB,LPS干预后,CNP显著升高,LPS 6 h达到高峰,与对照组比较有显著性差异(P0.05);相反,NPRB在LPS干预后出现表达降低,与对照组比较有显著性差异(P0.05)。结论CNP与NPRB的表达变化可能是导致肺损伤加重的重要原因之一。     

Effect of monochloramine on recovery of gastric mucosal integrity and blood flow response in rat stomachs--relations to capsaicin-sensitive sensory neurons.

Gastric mucosal blood flow (GMBF) response and the recovery of gastric mucosal integrity were investigated in anesthetized rat stomachs after damage by monochloramine (NH2Cl), in comparison with 20 mM taurocholate Na (TC). A rat stomach was mounted in an ex-vivo chamber, and the mucosa was exposed to 50 mM HCl during a test period. Mucosal application of 20 mM TC for 10 min caused a marked reduction of transmucosal potential difference (PD), but the PD recovered rapidly without development of gross lesions 90 min later. In contrast, the exposure of the mucosa to NH2Cl (5 to approximately 20 mM) produced a concentration-dependent decrease in gastric PD, and the values remained lowered even 90 min after removal of the agent, resulting in severe hemorrhagic damage in the stomach. TC caused a considerable H+ back-diffusion, followed by an increase in the GMBF. In the mucosa damaged by NH2Cl, such GMBF responses were not observed, except for the temporal increase during the exposure, although similar degrees of H+ back-diffusion were observed following NH2Cl treatment. In addition, the prior exposure of the mucosa to NH2Cl significantly attenuated gastric hyperemic response induced by capsaicin but not by misoprostol (a PGE1 derivative) or NOR-3 (a NO donor). Chemical ablation of capsaicin-sensitive sensory neurons had no effect on the PD reduction caused by TC but totally attenuated the GMBF response, resulting in hemorrhagic damage in the stomach. These results suggest that NH2Cl delayed the recovery of the mucosal integrity in the stomach after damage, and this effect may be attributable, at least partly, to the impairment of gastric hyperemic response associated with H+ back-diffusion, probably due to dysfunction of capsaicin-sensitive sensory neurons.     

Redistribution of blood flow after thermal injury and hemorrhagic shock

Diminished mucosal mass and a diminished rate of DNA synthesis by the intestinal mucosa have been identified in the rat after thermal injury. Because these changes may be associated with ischemia, the distribution of intestinal blood flow was studied after a thermal injury and compared with the blood flow distribution after hemorrhagic shock. For the thermal injury, anesthetized animals received a standardized 20% body surface area, full-thickness injury and were given intraperitoneal saline resuscitation. By the use of 46Sc- or 141Ce-labeled microspheres, no changes in intestinal and hepatic blood flow occurred after thermal injury. In contrast, a marked redistribution of blood flow was identified after hemorrhagic shock in which a decrease in arterial blood flow was identified to the stomach and to the small and large intestine. Although clinical shock was not present, the cardiac output decreased to a comparable degree in the hemorrhagic shock and the thermal injury. These studies indicate that although physiological changes in intestinal mucosa can be demonstrated after burn injury, these changes are not due to decreases in mesenteric arterial blood flow.     

Receptor-activating peptides for PAR-1 and PAR-2 relax rat gastric artery via multiple mechanisms

Receptor-activating peptides for protease-activated receptors (PARs) 1 or 2 enhance gastric mucosal blood flow (GMBF) and protect against gastric mucosal injury in rats. We thus examined and characterized the effects of PAR-1 and PAR-2 agonists on the isometric tension in isolated rat gastric artery. The agonists for PAR-2 or PAR-1 produced vasodilation in the endothelium-intact arterial rings, which was abolished by removal of the endothelium. The mechanisms underlying the PAR-2- and PAR-1-mediated relaxation involved NO, endothelium-derived hyperpolarizing factor (EDHF) and prostanoids, to distinct extent, as evaluated by use of inhibitors of NO synthase, cyclo-oxygenase and Ca2+-activated K+ channels. The EDHF-dependent relaxation responses were significantly attenuated by gap junction inhibitors. These findings demonstrate that endothelial PAR-1 and PAR-2, upon activation, dilate the gastric artery via NO and prostanoid formation and also EDHF mechanisms including gap junctions, which would enhance GMBF.     

急性肺损伤大鼠肺组织高迁移率族蛋白1的表达及其意义

目的动态观察高迁移率族蛋白1（HGMB1）在失血性休克复合内毒素注射致急性肺损伤（ALl）大鼠肺组织的表达情况,初步探讨HMGB1在ALI发病机制中的作用。方法采取失血性休克复合内毒素注射手段建立ALl大鼠动物模型,采用RT-PCR方法,检测肺组织HMGB1mRNA的表达情况。结果正常大鼠肺组织有少量HMGBlmRNA表达,遭受失血性休克复合内毒素注射打击后,HMGB1mRNA表达迅速升高,至ALI24h达最高峰,随后有所下降,ALl各组大鼠表达水平与正常对照组比较差异均有统计学意义（P〈0．01）。结论正常大鼠肺组织有一定水平HMGBlmRNA的表达,遭受失血性休克及内毒素注射打击后,HMGBlmRNA表达异常增高,可引起过度炎症反应,从而促进ALI的发生与发展。