七氟醚对失血性休克巴马小型猪肠黏膜屏障功能的影响

The effects of sevoflurane on gut barrier＇s function during hemorrhagic shock in bama miniature pigs

目的通过观察七氟醚对失血性休克巴马小型猪肠黏膜屏障功能的影响，以探讨七氟醚对其的保护作用。方法按随机数字表法将24头巴马小型猪随机分为4组（每组6只）：对照组（S组）、失血性休克组（HS组）、七氟醚预处理组（Pre／Sev组）及七氟醚后处理组（PosffSev组）。s组只行股动脉和颈内静脉置管，不建立失血性休克模型；HS组麻醉置管后建立失血性休克模型；Pre／Sev组麻醉置管后给予2％七氟醚吸入30min后建立失血性休克模型；Post／Sev组于麻醉置管建立失血性休克模型成功后给予2％七氟醚吸入30min。各实验组均于麻醉前（R）及失血性休克后30min（T1）、1h（T2）、1．5h（T3）、2h（T4）、3h（T5）、4h（T6）时间点于颈内静脉采血，ELISA法检测血清肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、白细胞介素石（interleukin-6，IL-6）、D-乳酸和肠脂肪酸结合蛋白（intestinal fattcid binding protein，I-FABP）的含量。失血性休克4h后放血处死实验动物取肠组织制作病理切片，苏木精咿红（hematoxylin-eosin，HE）染色观察各组病理组织学变化；并取下腔静脉血、肠系膜淋巴结、肝、肺、肾、脾组织进行细菌培养，计算远隔器官细菌移位率。结果与s组比较，HS组、Pre／Sev组和Post／Sev组血清D哥L酸、I-FABP、IL-6、TNF-α含量和远隔脏器细菌移位率均显著升高，差异有统计学意义（P〈0．05）。与HS组比较，Pre／Sev组和PosffSev组血清D晋L酸、I-FABP、IL-6、TNF-α含量均显著降低，差异有统计学意义（P〈O．05）。Pre／Sev组和PosffSev组的细菌移位率分别是36．11％和33．33％，明显低于HS组的69．44％（P〈0．05）。Pre／Sev组和PosffSev组比较，上述指标差异无统计学意义（P〉0．05）。光镜显示，S组肠黏膜未见明显变化；HS组肠黏膜屏障损伤严重，可见肠黏膜出血，炎性细胞浸润，上皮细胞坏死；Pre／Sev组和PosffSev组肠黏膜损伤明显减轻，仅见黏膜层腺体轻度扩张，上皮层和固有层中度分离，上皮下间隙轻度水肿，少许炎细胞浸润。结论七氟醚可减轻失血性休克引起的肠黏膜屏障损伤，其保护机制可能与抑制炎性反应有关。

Objective To observe the effects of sevoflurane on the intestinal barrier＇s function during hemorrhagic shock in Bama miniature pigs. Methods Twenty-four Bama miniature pigs were randomly divided into four groups （n=6） using a random number table ： sham group （group S）, hemorrhagic shock group （group HS ）, sevoflurane preconditioning group （group Pre/Sev）and sevoflurane postconditioning group （group Post/Sev）. In group S, the catheters were only placed into the femoral artery and the jugular vein after anesthesia. The hemorrhagic shock model was established in the other three groups through the femoral artery bleeding after anesthesia and catheterization. In group Pre/Sev, 2% sevoflurane was inhaled for 30rain before establishing the shock model. In Post/Sev group, 2% sevoflurane was inhaled for 30min after establishing the shock model. Blood samples were collected at 7 time points： prior to anesthesia（T0）, after hemorrhagic shock 30 min （T1）, 1 h （T2）, 1.5 h （T3）, 2 h （T4）, 3 h （T5）, 4 h （T6）. The contents of Interleukin -6 （ IL-6 ）, tumor necrosis factor -α （TNF -α ）, D -lactate and intestinal fattcid binding protein （I -FABP） in Serum were detected by ELISA. The intestinal tissues were collected at 4 h after shock. Hematoxylin-eosin （HE） staining technique was used to observe histological changes of the intestinal tissues. Vena cava blood and tissue samples were used to detect bacterial growth. Results Compared with group S, the serum TNF-α, IL-6, I-FABP, D-Lac contentions and the bacterial translocation rates significantly increased in group HS, Pre/Sev and Post/Sev （P〈0.05）. Compared with group HS, the above indices significantly reduced in group Pre/Sev and Post/Sev（P〈0.05 ） and the bacterial translocation rates were 36.11% and 33.33%, much lower than that of group HS （69.44%, P〈0.05）. There was no significant difference in the above indices at each time point between group Pre/Sev and group Post/Sev （P〉O.05）. These results were confirmed by HE staining. Conclusions Sevoflurane could improve, to some extent, pig＇s intestinal barrier＇s function during hemorrhagic shock and this effect is likely related to inhibition of the HS-induced inflammatory response.