早期间断腹腔灌洗联合抗生素对重症急性胰腺炎大鼠的影响  

Study on the therapeutic effect of interrupted peritoneal lavage combined with antibiotics on severe acute pancreatitis in rats

作　　者：吴裕林[1] 卢榜裕[1] 

机构地区：[1]广西医科大学第一附属医院,南宁市530021

出　　处：《微创医学》2012年第5期457-462,共6页Journal of Minimally Invasive Medicine

基　　金：广西区教育厅科学技术研究专项课题(基金编号:02601209005)

摘　　要：目的通过动物实验初步评估早期间断腹腔灌洗(PL)联合抗生素对重症急性胰腺炎(severe acute pancreatitis,SAP)治疗的影响。方法成年Wistar大鼠56只,雌雄各半,随机分组:假手术(SO)对照组、SAP无抗生素+未置管组(SNANT)、SAP无抗生素+置管组(SNAT)、SAP抗生素+置管组(SAT)、SAP抗生素+未置管组(SANT)、SAP-PL抗生素组(APL)和SAP-PL无抗生素组(NAPL);每组8只。采用胆胰管逆行性缓慢注射5%牛黄胆酸钠溶液(0.02 ml/100 g)建立大鼠SNANT和SANT模型;在SNANT模型的基础上于右下腹部放置腹腔引流管建立大鼠重症急性胰腺炎SNAT、SAT、APL和NAPL模型,引流管固定于鼠尾部。PL组在成功造模后12 h于麻醉状态下行腹腔灌洗,每12 h 1次,共4次。应用抗生素组则于造模之后12 h或灌洗结束时行腹腔内注射抗生素[左氧氟沙星注射液40 mg/(kg.d)+甲硝唑注射液90 mg/(kg.d)],每12 h 1次,共4次。用药和(或)灌洗完成12 h后收集标本。用酶联免疫吸附测定(ELISA)法检测血清中细胞因子肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、白介素-8(IL-8)、内毒素即脂多糖(LPS)的含量变化,HE染色光镜下观察胰腺组织病理形态学改变并评分。结果①与SO组相比,SAP组和PL组血中LPS、TNF-α、IL-6、IL-8水平均显著升高(P<0.05);与SNANT组相比,SNAT组和NAPL组血中LPS、TNF-α、IL-6、IL-8水平无显著差异(P>0.05);与SANT组相比,SAT组和APL组血中LPS、TNF-α、IL-6、IL-8水平无显著差异(P>0.05);与SNANT组、SNAT组和NAPL组相比,SANT组、SAT组和APL组血中LPS、TNF-α、IL-6、IL-8水平均显著降低(P<0.05);与NAPL组相比,APL组血中LPS、TNF-α、IL-6、IL-8水平均显著降低(P<0.05)。②胰腺病理检查:SAP各组胰腺组织小叶间隙增大、粒细胞浸润、脂肪坏死、实质出血、小叶坏死或缺失;PL各组胰腺组织小叶间隙较SAP组明显增大、粒细胞浸润、脂肪坏死、实质出血、小叶坏死或缺失;SO组仅见散发胰腺小叶间区�Objective To evaluate the therapeutic effect of interrupted peritoneal lavage （PL） combined with antibiotics on the severe acute pancreatitis in rats. Methods Fifty-six adult Wistar rats （280 g-350 g） were randomly divided into sham operation（SO） group, SAP groups of non-antibiotics ＋ non-drainage tube （SNANT） group, of non-antibiotics ＋ drainage tube（SNAT） group, of antibiotics ＋ drainage tube （SAT） group, of antibiotics ＋ non-drainage tube （SANT）, of SAP ＋ PL groups included antibiotic ＋ peritoneal lavage （APL） group, and of non-antibiotics ＋ peritoneal lavage（NAPL） group,with 8 rats in each group. SNANT and SANT models were produced by slow retrograde infusion of 5% sodium taurocholate solution （0.02ml/100g） into the common biliopancreatic duct in Wistar rats. In the SNAT, SAT, APL and NAPL groups, abdominal cavity drainage tube with side holes was introduced into the abdominal cavity at the right lower quadrant of the abdomen based on the SNANT models, and was tied to the rat tail Peritoneal lavage was performed with normal saline at ambient temperature and narcosis after 12 hours of successful induction of animal models, once per 12 hours and four times in total. The intraperitoneal injection of antibiotics （Left oxygen Buddha injection 40 mg/kg ＋ Metronidazole Injection 90 mg/kg） was performed once in every 12 hours after successful induction of animal models in SANT and SAT groups or next to the termination of peritoneal lavage in APL group. Blood sample and pancreatic tissue were obtained after 12 hours of injection of antibiotics and peritoneal lavage. The blood levels of tumor necrosis factor-α （TNF-ct）, Interleukin-6 （IL-6）, Interleukin-8 （IL-8）, lipopolysaccharide （LPS） were measured by enzyme-linked immunosorbent assay （ELISA）. The changes of pathological morphology of pancreatic tissue were evaluated and scored under light microscope after staining with hematoxylineosin-stain. Results （ 1 ） Compared with the SO grou

关 键 词：重症急性胰腺炎 早期 腹腔灌洗 抗生素 细胞因子 动物实验 

分 类 号：R576.1[医药卫生—消化系统]