羟乙基淀粉溶液对猪小肠移植缺血再灌注损伤的保护作用

The protection of hydroxyethl starch on ischemic-reperfusion injury in pig intestinal

目的探讨羟乙基淀粉溶液做为器官灌洗液对猪小肠移植缺血再灌注损伤的保护机制。方法建立同种异体猪原位节段性小肠移植模型。对照组和实验组分别采用0.9%生理盐水(n=6)和3%羟乙基淀粉氯化钠溶液(n=6)灌洗,移植小肠(截取供体约500 cm 小肠)保存于4℃0.9%生理盐水2 h。分别于移植前30 mim 和再灌注后30 min 采取肠液和血清,检测 ALT、CK、LDH 的变化;测定再灌注后肠液分泌量;检测血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、IL-6的含量。同时取移植小肠行病理学检查。结果再灌注30 min 后,实验组肠液分泌量明显少于对照组(P<0.05),两组肠液中 CK 水平较术前明显增加(P<0.05),实验组肠液中 CK 水平明显低于对照组(P<0.01);对照组再灌注30 min 后血清 TNF-α、IL-6、IL-1的含量较术前明显增加(P<0.05),实验组与术前无明显变化(P>0.05);两组再灌注30 min 后肠液和血清 ALT、LDH 的水平与术前无明显变化(P>0.05);对照组血清中 CK 明显低于实验组(P<0.05);实验组肠黏膜的组织损伤程度较对照组减轻。结论3%羟乙基淀粉氯化钠溶液可能通过抑制 TNF-α、IL-6、IL-1水平,阻止毛细血管渗漏,减轻细胞水肿,防止肠缺血再灌注损伤,再灌注后肠液分泌量及肠液CK 水平可用来判定肠组织损伤程度。

Objective To observe the effect of hydroxyethl starch （HES） on ischemic-reperfusion injury （IRI） in pig instestinal. Methods To establish the model of homotopic segmental small bowel transplantation in homogeneity pig, 12 pigs were randomly divided into two groups, donor intestine was infused by 0.9% NaC1 solution （controll group, n = 6） and 3% HES （test group, n = 6） and were stored in 4 ℃ 0.9% NaCl solution for 2 hours. The level of Alanine aminotransfetase （ALT） , creatine kinase （CK） and lactate dehydrogenase （LDH） in intestinal juice and serum were measured in preoperative and reperfusion 30 minutes later. The intestinal juice was harvested at 30 minutes after reperfusion. TNF-α,IL- 6,IL-1 level in serum was determined by ELISA method and the pathological change of intestinal tissue were investigated. Results In control group, the levels of TNF-α, IL-6 and IL-1 inserum after reperfusion 30 minutes were higher obviously than those before operation, but the change was not seen in the experi- ment group. The levels of ALT, LDH in intestinal juice and serum after reperfusion 30 minutes did not change significantly in both groups increased. Compared to NaCl solution group ,the level of CK in intestinal juice was lower, but in serum it is just opposite. Compared to NaCl solution group ,the tissue damage of intestinal mucosa is lower obviously in HES group after reperfusion 30 minutes. Conclusion 3% HES solution can preserve intestinal ischemic-reperfusion injure ,which maybe mediated by inhibiting TNF-α, IL- 6 ,IL-1 expression. The change of intestinal juice volume and ALT, CK, LDH level of intestinal juice can beused to estimate the tissue damage degree.