美蓝与透明质酸钠预防和减少腹部手术后腹膜粘连的研究

Comparative Study of Reduction and Prevention of Surgery-induced Peritoneal Adhesion By Methylene Blue and Hyaluronate Sodium

目的 对比研究了美蓝和透明质酸钠在临床上预防和减少腹部手术后腹膜粘连的作用及可能的机理。方法 4 6例急性弥漫性腹膜炎及粘连性肠梗阻手术病人被随机分为 3组 :美蓝组、透明质酸钠组及对照组。观察术后病人恢复情况及血清丙二醛 (MDA)含量 ,肿瘤坏死因子α(TNFα)水平及血红细胞超氧化物歧化酶 (SOD)活力的变化。结果 美蓝组病人术后恢复优于对照组 (P <0 0 1) ,与透明质酸钠组无明显差异。美蓝组术后血清MDA含量明显低于透明质酸钠组及对照组 (P <0 0 0 1) ,血红细胞SOD活力明显高于透明质酸钠组及对照组 ,血清TNF水平美蓝组明显低于对照组 ,但与透明质酸钠组无明显差异。结论 美蓝可以预防和减少腹部手术后腹膜粘连 ,作用与透明质酸钠相近 ,但其作用的机理与透明质酸钠不同 ,可能与美蓝抑制氧自由基的产生 ,降低TNFα水平 ,从而减轻了腹膜损伤有关。

Objective To study comparatively reduction and prevention of surgery-induced peritoneal adhesion by methylene blue and hyaluronate sodium. Methods 46 patients with acute diffuse peritonitis or adhesion intestinal ileus were divided at random into 3 groups: methylene blue ( MB) group, hyaluronate sodium (HS) group and control ( C ) group. The alteration of postoperation recovery,serum MDA, TNFα and erythrocytes SOD in patients were investigated. Results The recuperation in group MB was better than in group C (P<0.001), There was no difference between group MB and group HS. The level of serum MDA in group MB was significantly suppressed than that in group HS and group C(P<0 001), erythrocytes SOD activities in group MB were higher significantly than that in group HS and group C (P<0 001). The level of serum TNFα in group MB was reduced obviously than that in group C (P<0.001).However,there was no difference between group MB and group HS. Conclusions Methylene blue is similar to hyaluronate sodium in action,both may reduce and prevent surgery-induced peritoneal adhesion.MB action mechanism is diferent from HS,maybe related to suppression in production of oxygen-derived free radicals, and depression in the level of serum TNFα, dimishing on peritoneum injure.