甘草喷雾剂防治大鼠全麻气管插管呼吸道并发症作用机制研究

Study on the mechanism of Licorice Spray in prevention and treatment respiratory tract complications after general anesthesia trachea intubation in rats

目的:通过观察甘草喷雾剂在不同时间点给药,对大鼠气管插管后呼吸道黏膜病理学变化、血清炎性因子的表达及应激反应水平的影响,探讨其可能的保护机制。方法:选用SPF级大鼠90只,随机分组。第一组:模型对照组C组;第二组A组(诱导前30min给药组):A1组(甘草喷雾剂低剂量)、A2组(甘草喷雾剂中剂量)、A3组(甘草喷雾剂高剂量)、A4组(利多卡因组);第三组B组(诱导前10min给药组):B1组(甘草喷雾剂低剂量)、B2组(甘草喷雾剂中剂量)、B3组(甘草喷雾剂高剂量)、B4组(利多卡因)。采用气管插管法制作动物模型。分别于插管前(t0)、插管后(t1)、插管后30min(t2)、拔管后(t3)和拔管后30min(t4)测定血糖、皮质醇水平;插管60min后,拔出气管导管,用10%福尔马林溶液固定各组咽喉黏膜及其黏膜下层,切片进行组织病理学检查。每组股动脉采血,离心分离血清。检测TNF-α、IL-1及IL-10水平。结果:t0时,各组血糖、皮质醇水平差异均无统计学意义(P>0.05);在t1~t4时,A、B组甘草喷雾高、中剂量组与生理盐水组比较,差异均有统计学意义(P<0.05);在t1、t2时,A2组与B2组、A3组与B3组比较,差异均有统计学意义(P<0.05);在t3、t4时,A2组与B2组、A3组与B3组比较,差异均无统计学意义(P>0.05)。大鼠血清TNF-α、IL-1及IL-10含量甘草喷雾高、中剂量组与生理盐水组比较,差异均有统计学意义(P<0.05);A2组、A3组、A4组与A1组比较,B2组、B3组、B4组与B1组比较,差异均有统计学意义(P<0.05);A2组与B2组,A3组与B3组比较,差异均有统计学意义(P<0.05);A1组与B1组比较,差异无有统计学意义(P>0.05),A2组、A3组与A4组比较,B2组、B3组与B4组比较,差异均无统计学意义(P>0.05);A2组与A3组、B2组与B3组比较,差异均无统计学意义(P>0.05)。甘草各剂量组黏膜上皮表面炎性渗出较生理盐水组减轻,固有膜内炎性细胞浸润均较生理盐水组减轻,A组与B组甘草各对应剂量组差别不大。结论:甘草喷雾剂对大鼠气管插管后呼吸道黏膜具有保护作用,减轻气管插管时的应激反应,有利于防治气管插管呼吸道并发症,与全麻诱导前10min给药相比,诱导前30min给药效果更佳。

Objective:By observing the effects of Licorice Spray on the pathological changes of respiratory mucosal tissue,the expression of serum inflammatory factors and the level of stress response after tracheal intubation in rats at different time points,this article explored its possible protective mechanism.Methods:Ninety SPF rats were randomly divided into groups.Group 1:model control group C;group2 namely group A(dose 30min before induction):A1(Licorice Spray low dose group),A2(licorice spray medium dose group),A3(Licorice Spray high dose group),A4(Lidocaine group);group 3 namely group B(dose 10min before induction):B1(Licorice Spray low dose group),B2(Licorice Spray medium dose group),B3(licorice spray high dose group),B4(Lidocaine group).The animal model was made by tracheal intubation.Ser-um glucose and cortisol levels were detected before intubation(t0),after intubation(t1),30 min after intubation(t2),after extubation(t3),30 min after extubal-tion(t2)60 minutes after the intubation,pull out the tracheal catheter.The mucosa of pharynx and its underlying tissue were obtain respectively and fixed with 10%formalin solution.Then they were sectioned for histopathological examination.Blood was taken from femoral artery and centrifuge extraction of serum was conducted in each group,and the contents of TNF-α,IL-1 and IL-10 in serum were measured.Results:There was no statistical significance in blood glucose and cortisol level difference at the time of t0(P>0.05).At time point of t1-t4,the difference was statistically significant between high and medium dose group of licorice spray and normal saline group A and group B group(P<0.05).At the time point t1,t2,comparison of group A2 to group B2,as well as the comparison of group A3 to group B3,the difference was statistically significant(P<0.05).At the time point t3,t4,comparison of group A2 to group B2,as well as the comparison of group A3 to group B3,the difference was not stat-istically significant(P<0.05).The difference was statistically significant between high and med ium dose group of Licorice Spray group and normal Saline group in the content of TNF-α,IL-1 and IL-10 in serum of rats(P<0.05).Comparison of A2,A3 and A4 to A1 group,as well as the comparison of B2,B3 and B4 to B1 group,the difference was not statistically significant(P>0.05).Comparison of A2 to B2 group,as well as the comparison of A3 to B3 group,the difference was statistically significant(P<0.05).There was no significant difference between A1 group and B1 group(P>0.05).Comparison of A2,A3 to A4 group,as well as the comparison of B2,B3 to B4 group,the difference was not statistically significant(P<0.05).Comparison of A2 to A3 group,as well as the comparisi-on of B2 to B3 group,the difference was not statistically significant(P>0.05).The inflammatory exudation on mucosal epithelium surface of licorice groups of each dosage was less than that of normal saline group,The infiltration of inflammatory cells in the inner membrane was less than that in the normal saline group.There was no significant difference between the corresponding dosage groups of licorice in group A and B.Conclusion:Licoricespray has protective effects on the respiratory tract mucosa after tracheal intubation.It could relieve the stress reaction in trache-al intubation of rats,which is beneficial to prevent and cure respiratory tract com-plication of general anesthesia tracheal intubation.Comparing to dosing 10 min before induction,the effect of 30min before induction has a better outcome.