大鼠创伤失血性休克复苏后肠道粘膜屏障的形态改变

Morphological Study of Intestinal Mucosal Barrier in Rat after Traumatic-Hemorrhagic Shock Resuscitation

目的 研究用常规大容量晶体联合小量胶体 (乳酸林格液 /6 %羟乙基淀粉 )复苏创伤失血性休克大鼠后肠粘膜形态学改变。 方法 应用光镜、常规电镜及电镜细胞化学的方法观察肠粘膜形态学变化。 结果 光镜见粘膜上皮细胞水肿 ,部分细胞坏死脱落糜烂 ,固有层水肿疏松 ,较多淋巴细胞及不等量的中性粒细胞浸润 ;电镜下见小肠粘膜上皮细胞表面微绒毛脱落 ,部分上皮细胞膜破损 ,细胞质基质外溢 ,部分细胞内线粒体肿胀 ,上皮细胞间及固有层可见淋巴细胞及中性粒细胞浸润 ,单宁酸染色见暗细胞明显增多。 结论 大鼠创伤失血性休克复苏后肠道粘膜确有受损 ,其改变可能与创伤失血性休克复苏后的细菌移位有关。

Objective To investigate the morphological changes of intestinal mucosal barrier after resuscitation of traumatic hemorrhagic shock with routine large volume crystalloid combined with small volume colloid solutions(lactic acid Ringer's solution/6% hydroethylstarch). Methods The morphological alterations were examined under light microscope and electron microscope. Results Under light microscope, swelling and necrotic mucosal cells and mucosal erosion were found in intestine. Lymphocytes and neutrophils infiltrating into tunica propria was also seen. Under electron microscope, microvilli of epithelial cells were lacked or disappeared, epithelial cells membrane was damaged, mitochondia were swelled. Lymphocytes and neutrophils infiltrated between epithelial cells or into tunica propria. Tannic acid staining showed that the number of dark cells increased after traumatic hemorrhagic shock resuscitation. Conclusion The injured changes in intestinal mucosa barrier can be detected actually under light and electron microscopes after resuscitation. These changes in intestinal mucosa are thought to be associated with bacterial translocation under this pathological condition.