不同血管活性药物对脓毒症休克兔肠屏障的影响  

Effects of different vasoactive agents on the intestinal barrier

作　　者：范晓春[1] 张铮[1] 秦海东[1] 鲍磊[1] 玉章锋[1] 陈琳[1] 

机构地区：[1]南京医科大学附属南京市第一医院急诊科,210006

出　　处：《中国急救医学》2010年第12期1102-1105,I0011,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的 评价不同血管活性药物对脓毒症休克兔肠黏膜通透性影响.方法 采用盲肠结扎穿孔联合静脉注入内毒素制备脓毒症休克模型,将63只新西兰大白兔随机分为假手术对照组（A组,n=7）、造模组（B组,n=14）、多巴胺组（C组,n=14）、去甲肾上腺素＋多巴酚丁胺组（D组,n=14）和去甲肾上腺素＋精氨酸升压素（arginine vasopressin,AVP）组（E组,n=14）,各组分别于造模后3、6 h 2个时相点处死7只,留取尿标本测定各时相点乳果糖与甘露醇比值（lactulose/mannitol, L/M） ,并留取回肠标本作光镜和电镜检查.结果 各组尿中L/M值在各时相点均高于A组;C组与B组比较,尿中L/M值在3、6 h差异均无统计学意义（P〉0.05）;D组尿中L/M值在3 h显著低于B组（P〈0.05）;E组尿中L/M值在3、6 h均显著低于B组（P〈0.05）.形态学观察发现D、E组回肠损伤明显轻于B、C组.结论 脓毒症休克时肠黏膜屏障损伤严重;去甲肾上腺素联用多巴酚丁胺或小剂量精氨酸升压素可以有效缓解脓毒症休克引起的肠形态和肠通透性改变;去甲肾上腺素联用小剂量精氨酸升压素效果可能更持久.Objective To evaluate effects of different vasoactive agents on the intestinal mucosal permeability in a rabbit model of septic shock. Methods A cecal ligation and puncture procedure combined with intravenous injection of Lipopolysaccharides was used to make septic shock model, sixty - three rabbits were randomly divided into 5 groups ： sham operation group （ group A, n = 7 ）, septic shock group（group B, n = 14）, dopamine group（ group C, n = 14）, norepinephrine combined with dobutamine group（group D, n = 14）and norepinephrine combined with arginine vasopressin group（group E, n = 14）. 7 rabbits from each group were sacrificed 3 and 6 hours after septic shock, a laetulose/mannitol（L/M） ratio test and the morphological changes were performed at 3 and 6 h. Results Urine L/M ratio in septic shock groups were significantly increased than that in group A, （P 〈 0.05 ）. No significant differences in the L/M ratio were found between group C and B at 3 and 6 h （ P 〉 0.05 ） ; group D at 3 h and group E at 3 and 6 h was significant lower than that in group B （P 〈 O. 05 ）. The morphological changes of intestinal were lessened in group D and E than those in group B and C. Conclusion Intestinal mucosal were injuried severely in septic shock model. Norepinephrine combined with dobutamine or AVP relieved lesion of intestinal morphology and permeability induced by septic shock. Moreover, norepinephrine combined with AVP may have better effects.

关 键 词：脓毒症休克 肠黏膜通透性 乳果糖与甘露醇比值 精氨酸升压素 

分 类 号：R589.2[医药卫生—内分泌]