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创伤性休克及复苏后肠粘膜免疫功能的改变 |
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刘霞 徐惠芳 江伟
摘要 目的：研究大鼠休克及复苏后胆汁IgA和血内毒素含量的变化及两者的相关性。方法：大鼠剖腹术后经股动脉放血及自体血回输的方法复制创伤性休克、复苏模型。结果：大鼠休克及复苏后胆汁IgA显著低于休克前，以复苏后24小时最低，并显著低于休克末(P＜0.05)。休克及复苏后大鼠门、体循环血内毒素含量均明显高于休克前，以复苏后24小时最高，并显著高于休克末(P＜0.05)。胆汁中IgA与血内毒素变化呈显著负相关。结论：创伤性休克及复苏后肠特异性免疫功能显著降低及血内毒素含量增加。
关键词 肠 免疫性 内毒素类 复苏 休克，创伤性
Experimental study of changes of intestinal immunity following traumatic shock and resuscitation Liu Xia，Xu Huifang，Jiang Wei．Department of Anesthesiology，the Sixth Peoples｀ Hospital，Shanghai 200233
Abstract Objective：We investigated experimentally the changes of intestinal immunity following shock and resuscitation after trauma．Method：The experimental model was made in rats，which underwent laparotomy，then bleeding and reinfusing through the right fetmoral artery．Result：The concentration of IgA following shock and resuscitation were significantly higher than that before shock．．The concentration of IgA 24 h following resuscitation was the lowest，and was significantly lower than that at the end of shock．．The endotoxin in portal vein following shock and resuscitation were higher than that before shock．．The endotoxin level 24 h following resuscitation was the highest，and markedly higher than that at the end of shock．Conclusion：The traumatic shock and resuscitation are capable of causing intestinal immunosuppression and endotoxemia．
Key words Intestines Immunity Endotoxins Resuscitation Shock，traumatic
IgA是肠道的特异性免疫物质，电镜观察70%～80%G－杆菌被IgA包裹，而引起内毒血症的细菌已证实主要是肠道G－杆菌，可见IgA在肠免疫功能中的作用。本文利用大鼠休克、复苏模型，探讨全身缺血再灌注后肠免疫功能的改变。
材料与方法
健康雄性SD大鼠60只，体重280±24g。实验前12小时禁食，但不禁水。
10%氯胺酮80mg/kg腹腔麻醉后，将大鼠仰卧位于操作板上，硫化钡腹部脱毛洗净，碘酊酒精消毒，以切口3cm行剖腹术。分离右侧股动脉，置入套管针后连三通器，接日本光电Nihon Kohden Life Scope 12 监测仪。20ml针筒肝素化(内含25U／ml的肝素)接三通器放血，血压降至5.32kPa(40mmHg)，认为休克开始〔1，2〕，维持该血压90分钟。放血量为13±3ml。然后将针筒内的自体血缓慢回输，血压恢复至基础值90%以上，认为复苏成功〔3〕。将套管针拔出，结扎股动脉，缝合切口，待大鼠清醒后放回笼内观察。
根据采样时间，随机分为6组，即休克前10分钟为休克前组，依次为休克末，复苏后6、24小时和3、7天。
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