大承气汤加味方对重症急性胰腺炎大鼠肠功能衰竭的干预作用

Intervention Effect of Supplemented Dachengqi Decoction on the Intestinal Failure in Rats with Severe Acute Pancreatitis

目的研究全程运用大承气汤加味方对重症急性胰腺炎(SAP)大鼠的肠功能恢复作用。方法将190只SD大鼠随机分为假手术组、模型组、早期组、生长抑素组、全程组,每组38只。采用肠壁穿刺逆行胰胆管注射5%牛黄胆酸钠建立SAP模型,造模3h后假手术组、模型组灌胃生理盐水,每12h1次;生长抑素组皮下注射生长抑素1.35μg/100g,每8h1次;早期组灌胃大承气汤加味方0.4ml/100g,6h后改为生理盐水,每12h1次;全程组灌胃大承气汤方0.4ml/100g,每12h1次。观察各组48h内大鼠死亡率、48h时间点肠系膜淋巴结细菌移位阳性率;分别于4、6、24、48h检测大鼠血和腹水淀粉酶(AMY)、血肿瘤坏死因子α(TNF-α)水平及大鼠胰腺、小肠组织病理评分。结果生长抑素组和全程组大鼠死亡率分别为18.4%、13.2%,均低于模型组的42.1%(P<0.05);全程组6、24、48h时血和腹水中AMY含量均低于同时间模型组(P<0.05),并且48h时低于同时间早期组(P<0.05)。全程组、早期组、生长抑素组6h血TNF-α低于模型组(P<0.05)。生长抑素组和全程组6、24、48h时胰腺、小肠组织病理评分均低于同时间模型组(P<0.05)。生长抑素组和全程组淋巴结细菌移位阳性率均为25%,低于模型组和早期组的100%(P<0.05)。结论全程运用大承气汤加味方能有效降低SAP大鼠血AMY,抑制细菌移位,改善肠功能恢复,优于早期运用大承气汤加味方。

Objective To study the recovery effect of Supplemented Dachengqi Decoction（Major Qi-Coordinating Decoction） on the intestinal function in rats with severe acute pancreatitis（SAP）.Methods Totally 190 SD rats were randomized into the sham operation group,model group,early group,somatostatin（SS） group and entire group,with 38 in each.The SAP models were established with retrograde injection of 5% sodium taurocholate into the pancreatic duct.The sham operation group and model group were gavaged with 0.4 ml/100 g normal saline（NS） 3 hours after modeling,once every 12 hours.The SS group was given subcutaneous injection of 1.35 μg/100 g SS once every 8 hours.The early group was gavaged with 0.4 ml/100 g Supplemented Major Qi-Coordinating Decoction and 6 hours later changed to 0.4 ml/100 g NS once every 12 hours.The entire group was gavaged with 0.4 ml/100 g Supplemented Major Qi-Coordinating Decoction once every 12 hours.The survival rate of rats and the positive rate of bacterial translocation in mesenteric lymph nodes within 48 h were observed.The amylase（AMY） contents in rat serum and ascites and serum tumor necrosis factor-α（TNF-α） levels were detected and the rat pancreas and small bowel pathology was scored at the 4th,6th,24th and 48th hour respectively.Results The survival rate of rats in the SS group and entire group was 70.8% and 79.2% respectively,which was significantly higher than 37.5% in the model group（P〈0.05）.The AMY contents in rat serum and ascites in the entire group at the 6th,24th and 48th hour were significantly lower than those in the model group at the same time points（P〈0.05）.The AMY contents in rat serum and ascites in the entire group at the 48th hour were significantly lower than those in the early group at the same time points（P〈0.05）.Comparing with the model group,the serum TNF-α levels in the entire group,early group and SS group were significantly decreased at the 6th hour（P〈0.05）.The pancreas and small bowel pathology scores in the SS group and entire group at the 6th,24th and 48th hour were significantly lower than those in the model group at the same time points（P〈0.05）.The positive rates of bacterial translocation in mesenteric lymph nodes in the SS group and entire group were 25%,which were lower than 100% in the model group and early group（P〈0.05）.Conclusion The entire application of Supplemented Major Qi-Coordinating Decoction can effectively decrease AMY,inhibit bacterial translocation and improve intestinal function recovery in rats with SAP,with a better therapeutic effect as compared with early application of Supplemented Major Qi-Coordinating Decoction.