犬剖腹探查手术对胃肠运动和血浆Ghrelin的影响及红霉素的促动力作用  

Effect of exploratory laparotomy on canine gastrointestinal motility and plasma ghrelin level and the prokinetic effect of erythromycin after operation

作　　者：陈志强[1] 尚文璠[2] 杨仁轩[3] 曹立幸[1] 王建春[4] 黄学阳[4] 赵高峰[5] 叶飞[5] 黄秋萍[6] 李钦盛[6] 陈其城[1] 周吕[7] 

机构地区：[1]广东省中医院围手术期中医药应用研究团队,广州510120 [2]广东省中医院胃肠动力室,广州510120 [3]广东省中医院骨科,广州510120 [4]广东省中医院外科,广州510120 [5]广东省中医院麻醉科,广州510120 [6]广东省中医院急诊科,广州510120 [7]中国医学科学院基础医学研究所,北京100005

出　　处：《中华内分泌代谢杂志》2013年第10期884-889,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：“十一五”国家科技支撑计划（2008 BA153B03）;广东省财政厅项目（粤财工[2011]381）

摘　　要：目的 研究犬剖腹探查手术对胃肠运动和血浆Ghrelin的影响以及红霉素对术后胃肠的促动力作用。方法 38只毕格犬随机分4组进行慢性实验。在胃窦、十二指肠、空肠和结肠浆膜植入应力传感噐记录清醒犬胃肠运动。颈外静脉内置慢性静脉插管供取血及注射药物。实验分组：对照组,剖腹探查手术组,剖腹探查手术＋红霉素组,剖腹探查手术＋生理盐水组。结果 （1）对照组：消化间期出现典型的消化间期移行性复合运动（MMC）周期。（2）剖腹探查手术组：术毕当日麻醉期胃肠运动没有MMC周期,胃窦、十二指肠、空肠收缩波总数增加,而结肠收缩波总数则减少。胃肠振幅指数明显下降,下降（70.76 ± 9.36）%～（92.51 ± 13.17）%（均P〈0.01）。术后1～5d清醒状态胃肠运动均无MMC周期,胃窦和结肠收缩波总数增加,十二指肠和空肠收缩波总数则减少。胃肠振幅指数明显下降,下降（33.83 ± 5.16）%～（70.71 ± 8.5）%（均P〈0.01）。无论麻醉期与清醒期,术后6～7d,胃肠运动逐渐恢复至正常水平。术后0～5d血浆Ghrelin水平与对照组比较明显下降（P〈0.01）。术后7dGhrelin恢复至正常水平。（3）剖腹探查手术＋红霉素组：静脉注射红霉素2mg/kg明显增强术后胃肠动力,并刺激Ghrelin释放。结论 腹部手术后胃肠运动出现明显紊乱,动力和血浆Ghrelin浓度均明显下降。红霉素在围手术期中具有明显的促动力作用,其作用通过内源性Ghrelin释放介导。Objective To study the effect of exploratory laparotomy on canine gastrointestinal motility and plasma ghrelin level, and to observe the prokinetic effect of erythromycin after operation. Methods Chronic experiment was carried out in 38 conscious Beagles. Strain gauges were implanted on antrum, duodenum, proximal jejunum, and distal colon to record gastrointestinal motility. Dogs were prepared with chronic gastric fistula in addition to a jugular vein cannulation. There were 4 groups：（1）Control group, no laparotomy, no erythromycin;（2）Exploratory laparotomy group;（3）Exploratory laparotomy＋erythromycin;（4）Exploratory laparotomy＋saline. Results （1）Control group showed typical interdigestive migrating motor complex（MMC）. （2）In the exploratomy laparotomy group, on the day of surgery, during recovery period from anesthetia, no MMC was recorded. The sum of contracting waves increased in antrum, duodenum, and jejunum but decreased in colon. The amplitude index significantly decreased（70.76 ± 9.36）% to（92.51 ± 13.17）%（all P〈0.01）. On postoperative day 1 to 5, there was no MMC in conscious dogs. The sum of contracting waves increased in antrum and colon, but decreased in duodenum and jejunum. The amplitude index significantly decreased （33.83 ± 5.16）% to（70.71 ± 8.5）%（all P〈0.01）. In both sedative and conscious status, by postoperative day 6 to 7, gastrointestinal motility recovered to baseline. On the postoperative day 0 to 5 the mean plasma ghrelin levels decreased markedly compared with the control group（P〈0.01）. By postoperative day 7, the ghrelin recovered to baseline. （3）In exploratory laparatory ＋erythromycin group, intravenous injection of erythromycin 2 mg/kg significantly increased the postoperative gastrointestinal motility and stimulated ghrelin release. Conclusions Gastrointestinal motility was significantly disturbed after exploratory laparatomy. The motility and plasma ghrelin concentration both decreased markedly. Erythromycin sh

关 键 词：剖腹探查手术 胃肠运动 胃促生长素 红霉素 

分 类 号：R-332[医药卫生]