红霉素、维拉帕米及低分子肝素对术后腹腔粘连的预防作用

Effects of erythromycin, verapamil and low molecular weight heparin on postoperative peritoneal adhesion in rats

目的探讨红霉素、维拉帕米、低分子肝素单用及联合用药对术后腹腔粘连的预防作用．方法采用两种动物腹腔粘连模型，将９０只大鼠随机分为５组：①对照组；②低分子肝素组（ＬＭＷＨ，３００ＩＵ／ｋｇ，ｉｐ，１次／８ｈ，连用３ｄ）；③红霉素组（Ｅｒｙ，８ｍｇ／ｋｇ首次舌ｉｖ，以后ｓｃ，时间同②）；④维拉帕米组（ＶＲＰ，２００μｇ／ｋｇ用药方法及时间同②）；⑤联合组：３种药物联合应用．所有动物术后９ｄ猝死，原切口入腹观察腹腔粘连情况．结果重创模型（模型Ⅰ）Ｅｒｙ组、ＶＲＰ组及联合组均与对照组有显著差异（１３±１１，１６±０７，１６±１１ｖｓ２９±１３，Ｐ＜００１，Ｐ＜００５）．ＬＭＷＨ组与对照组无显著差异（２１±１０ｖｓ２９±１３，Ｐ＞００５）．轻创模型（模型Ⅱ，以：粘连长度／缝合长度计分，％表示）３个单一用药组及联合组均与对照组有显著差异（３３±２２，２５±１６，２９±２６，９±２１ｖｓ５２±２７，Ｐ＜００５）．联合组粘连比值明显低于３个单一用药组（９±２１ｖｓ３３±２２，２５±１６，２９±２６，Ｐ＜００５）．结论红霉素、低分子肝素及维拉帕米均可预防不同程度的腹腔粘连，联合用药效果对轻型创?

AIM To investigate the effect of erythromycin (Ery), verapamil (VRP) and low molecular weight heparin (LMWH) on postoperative peritoneal adhesions. METHODS The adhesions were induced at laparotomy by two different operative models. The 90 rats were randomly divided into 5 groups: ①control; ②LMWH ( 300IU/kg ip); ③Ery ( 8mg/kg sc); ④VRP ( 200μg/kg ip); and ⑤combined (LMWH+Ery+VRP). All animals were reexplored at the 9th day postoperatively for evaluation of adhesion formation. RESULTS In model Ⅰ, there were significant differences between Ery, VRP, combined and control group (1 3±1 1, 1 6±0 7, 1 6±1 1 vs 2 9±1 3, P <0 01, P <0 05). No significant difference was found between LMWH and control group (2 1±1 0 vs 2 9±1 3, P >0 05). In model Ⅱ, there were marked differences between LMWH, Ery, VRP, combined and control group (33±22, 25±16, 29±26, 9±21 vs 52±27, P <0 05). The degree of adhesion formation was markedly reduced in the combined group comparing with LMWH, Ery, and VRP group (9±21 vs 33±22, 25±16, 29±26, P <0 05). CONCLUSION LMWH, Ery and VRP may prevent the postoperative adhesion formation and combined effects are better than the effect of single drug on adhesion.