亚低温对创伤性颅脑损伤后胃肠动力学影响的实验研究

Effect of mild hypothermia on gastrointestinal motility after traumatic brain injury： an experimental study

目的探讨亚低温对创伤性脑损伤（TBI）后胃肠动力的影响。方法选取成年健康雄性sD大鼠75只，按照随机数字表法分为假手术组（Sham）、创伤组（TBI）、亚低温组（MIH）。应用电子脑皮质撞击仪（eCCI）建立大鼠TBI模型，随即亚低温干预4h。分别检测各组大鼠胃动力、胃排空率、小肠推进率改变；动物处死后分别获取脑、胃、回盲部、距回盲部15cm处小肠组织，HE染色观察其病理变化。结果大鼠TBI后胃明显扩张，胃壁变薄，胃黏膜充血、水肿，部分黏膜上皮脱落，黏膜下层有出血，肠腔扩张胀气，肠黏膜出血坏死、绒毛脱落、中性粒细胞浸润，绒毛间隙增大，杯状细胞减少。胃黏膜充血血管计数和肠黏膜绒毛断裂数显示6hTBI组与MIH组相比差异无统计学意义（P〉0．05），24h、48h和72hMIH组与TBI组相比差异有统计学意义（P〈0．05）。胃动力学检测显示各组胃运动频率相比差异无统计学意义（P〉0．05）；胃运动波幅值TBI和MIT组均高于Sham组，差异有统计学意义（P〈0．05），24h后MIT组低于TBI组，差异有统计学意义（P〈0．05）。胃排空率，小肠推进率测定显示6hTBI组和MIH组相比差异无统计学意义（P〉0．05），24h、48h和72h MIH组与TBI组相比差异有统计学意义（P〈0．05）。结论TBI对大鼠胃肠黏膜和胃肠动力皆有影响，MIH干预后短期效应不显但长期疗效显著。

Objective To investigate the effect of mild hypothermia on gastrointestinal motility after traumatic brain injury （TBI）. Methods A total of 75 adult male SD rats were randomly divided into a sham operation （Sham） group, a traumatic brain injury （TBI） group, and a mild hypothermia （MIH） group according to a random number table. A rat model of TBI was induced by using the electric cortical contusion impactor （eCCI） , and then the mild hypothermia inteivened for 4 h. The changes of gastric motility, gastric emptying rate, and intestinal propulsive rate in each group were detected. After the animals were sacrificed, the brain, stomach, ileocecal junction, and small intestine tissue 15 cm from ileocecal junction were obtained respectively. HE staining was used to observe its pathological changes. Results After TBI in rats, the stomach obviously dilated, the stomach wall became thinner, gastric mucosa was congested and edematous, part of the mucosa had epithelial shedding, there was bleeding in submucosa, there was lumen expansion and flatulence, intestinal mucosa had hemorrhage and necrosis, intestinal villi desquamated, there was neutrophil infiltration, the gaps of intestinal villi increased, and Goblet cells decreased. The blood vessel count of gastric mucosal congestion and the numbers of intestinal mucosa villi fracture showed that there was no significant difference between the 6 h TBI group and the MIH group （ P 〉 0.05 ）. Compared with the TBI group, there were significant differences in the 24, 48 and 72 h MIH groups （P 〈 0.05 ）. Gastric motility detection showed that there were no significant differences in gastric motility frequencies among all the groups （ P 〉 O. 05 ） ; the value of gastric motor amplitude of the TBI and MIT groups was higher than that of the sham group （ P 〈 0.05 ）. The MIT group was lower than the TBI group after 24 h （ P 〈 0. 05）. There was significant difference （P 〈 0.05 ）. The determination of gastric emptying rate and intestinal propulsion rate showed that there was no significant difference between the 6 h TBI group and the MIH group （P 〉 0.05）. Compared with the TBI group, there were significant differences among the 24, 48 and 72 h MIH groups （P 〈 0.05）. Conclusions TBI had effect on rat gastrointestinal mucosa and gastrointestinal motility. The short-term effect after MIH intervention was not significant, but the long-term efficacy was remarkable.