肝性脑病食醋灌肠导致肠黏膜屏障损伤及改进方法  

Damage of Intestinal Mucosal Barrier Caused by Vinegar Enema and Improvement for Hepatic Encephalopathy

作　　者：张凤[1] 徐旭娟[2] 沈美云[2] 

机构地区：[1]南通大学护理学院,江苏省南通市226001 [2]南通大学附属医院

出　　处：《天津医药》2013年第9期901-903,I0006,共4页Tianjin Medical Journal

基　　金：江苏省南通市应用研究计划科技项目(项目编号:BK2013025)

摘　　要：目的探讨肝性脑病食醋保留灌肠对肠黏膜屏障的损伤,并比较传统高渗食醋灌肠液与改进的等渗食醋灌肠液对兔肠黏膜屏障的损伤程度。方法选用成年家兔16只,随机分为2组,高渗组灌肠液为生理盐水和白醋混合成的高渗溶液;等渗组灌肠液为双蒸水和白醋混合的同等pH值和体积分数的等渗溶液。在相同灌肠条件下,使用不同渗透压食醋灌肠液给动物保留灌肠。通过肠黏膜病理切片,光镜下观察肠黏膜结构改变,电镜下观察细胞结构及紧密连接情况,比较2组肠黏膜屏障损伤程度。结果光镜下可见等渗组直肠部位与远端结肠肠黏膜损伤程度较高渗组轻。电镜下,等渗组细胞形态正常,微绒毛排列整齐,细胞连接紧密;高渗组微绒毛减少或消失,细胞连接增宽或开放,细胞核固缩,并可见凋亡、坏死细胞。结论等渗性食醋灌肠液对肠黏膜屏障损伤较传统高渗性食醋灌肠液轻。临床上肝性脑病患者可选用等渗性食醋灌肠液以减少渗透压对肠黏膜屏障的损伤。Objective To explore the damage of intestinal mucosal barrier caused by vinegar retention enema, and compare the degree of injury in intestinal mucosal barrier between isotonic vinegar and traditional hypertonic vinegar treatment. Methods Sixteen adult rabbits were randomly divided into two groups. The solution of vinegar mixed with normal sodium was given to hypertonic group. Isotonic group was administered with isosmotic solution made of vinegar and double distilled water, with the same volume fraction and pH as hypertonic group. Then two different osmosis solutions were given as enema solution to rabbits under the same condition. Finally, damages of intestinal mucosa were observed by light microscope and transmission electron microscope （TEM） in two groups. Results It was observed that injuries of rectum and distal part of colon were more severe in hypertonic group than those of isotonic group through light microscope. Besides, cell structures were morphologically normal, with in-line microvilli and intact tight junction in isotonic group. In hypertonic group, microvilli of intestinal cells decreased or disappeared, the cell junction is widened, and cell apoptosis and necrosis were found through TEM. Conclusion Resuhs showed that isotonic vinegar had less damage to mucosa. Consequently, isotonic vinegar can be considered as enema solution for hepatic encephalopathy to avoid damage by osmosis in clinic.

关 键 词：醋酸 等渗溶液 高渗溶液 灌肠 肝性脑病 肠黏膜屏障 

分 类 号：R333.3[医药卫生—人体生理学]