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“休克肠”的防治现状
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作者 杨惠玲 武继军 赵京山 《中国中西医结合急救杂志》 CAS 2008年第5期316-318,共3页
临床防治“休克肠”意义重大,防治方法复杂多样,都各有其优缺点,而且需要进一步研究,现综述如下。 1“休克肠”的定义 与严重战创伤、大面积烧伤、严重感染、休克等伤害因素并存的潜在肠道低血压、肠道低灌注或隐性肠道休克可导... 临床防治“休克肠”意义重大,防治方法复杂多样,都各有其优缺点,而且需要进一步研究,现综述如下。 1“休克肠”的定义 与严重战创伤、大面积烧伤、严重感染、休克等伤害因素并存的潜在肠道低血压、肠道低灌注或隐性肠道休克可导致肠道黏膜缺血、缺氧,屏障功能障碍,并诱发出肠源性全身炎症反应综合征(SIRS)、多器官功能障碍综合征(MODS)等系列反应,称为“休克肠”。 展开更多
关键词 “休克肠” 防治 内营养
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“休克肠”与多脏器功能障碍 被引量:24
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作者 屠伟峰 肖光夏 《中华麻醉学杂志》 CAS CSCD 北大核心 2002年第2期125-128,共4页
近代研究提示严重创(烧)伤后,虽伤在表面,但深部组织与器官有明显的反应.在诸多器官中,肠道是最敏感器官之一.由于肠道作为体内最大的"贮菌所"和"内毒素库",其粘膜完整性和屏障功能一旦受到缺血缺氧性损害的前提下... 近代研究提示严重创(烧)伤后,虽伤在表面,但深部组织与器官有明显的反应.在诸多器官中,肠道是最敏感器官之一.由于肠道作为体内最大的"贮菌所"和"内毒素库",其粘膜完整性和屏障功能一旦受到缺血缺氧性损害的前提下,肠腔内细菌/毒素向肠道外组织器官的移位可引发肠道局部或全身性不可控制的炎症反应和促炎介质的过度释放,认为胃肠道是全身性炎症应答综合征(SIRS)的触发器和始动器,是脓毒症和多脏器功能障碍综合征(MODS)的"中心器官"(motor)[1,2].继"休克肾"、"休克肺"救治取得长足进步后,在创伤与胃肠功能障碍系列研究的基础上,提出了"休克肠"的概念,以引起从事临床医学尤其创伤、危重医学、麻醉医学的医务人员和科研工作者的高度重视,并期望取得新的突破."休克肠"是指诸伤害因素如严重作战创伤、大手术(如心胸手术、颅脑手术、器官移植)、大面积烧伤、严重感染、休克等所并存的潜在的肠道低血压、低灌注或隐性肠道休克,导致肠道粘膜缺血缺氧、肠道功能障碍,并诱发肠源性SIRS、MODS系列症候群. 展开更多
关键词 道细菌 内毒素 移位 “休克肠” 多脏器功能障碍
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Functional and morphological changes of the gut barrier during the restitution process after hemorrhagic shock 被引量:45
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作者 Jian-Xing Chang Shuang Chen +7 位作者 Li-Ping Ma Long-Yuan Jiang Jian-Wen Chen Rui-Ming Chang Li-Qiang Wen Wei Wu Zhi-Peng Jiang Zi-Tong Huang 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第35期5485-5491,共7页
AIM: To investigate the functional, morphological changes of the gut barrier during the restitution process after hemorrhagic shock, and the regional differences of the large intestine and small intestine in response... AIM: To investigate the functional, morphological changes of the gut barrier during the restitution process after hemorrhagic shock, and the regional differences of the large intestine and small intestine in response to ischemia/ reperfusion injury. METHODS: Forty-seven Sprague-Dawley rats with body weight of 250-300 g were divided into two groups: control group (sham shock n = 5) and experimental group (n = 42). Experimental group was further divided into six groups (n = 7 each) according to different time points after the hemorrhagic shock, including 0^th group, 1^st group, 3^rd group, 6th h group, 12^th group and 24^th group. All the rats were gavaged with 2 mL of suspension of lactulose (L) (100 mg/2 mL) and mannitol (M) (50 mg/each) at the beginning and then an experimental rat model of hemorrhagic shock was set up. The specimens from jejunum, ileum and colon tissues and the blood samples from the portal vein were taken at 0, 1, 3, 6, 12 and 24 h after shock resuscitation, respectively. The morphological changes of the intestinal mucosa, including the histology of intestinal mucosa, the thickness of mucosa, the height of villi, the index of mucosal damage and the numbers of goblet cells, were determined by light microscope and/or electron microscope. The concentrations of the bacterial endotoxin lipopolysaccharides (LPS) from the portal vein blood, which reflected the gut barrier function, were examined by using Limulus test. At the same time point, to evaluate intestinal permeability, all urine was collected and the concentrations of the metabolically inactive markers such as L and M in urine were measured by using GC-9A gas chromatographic instrument.RESULTS: After the hemorrhagic shock, the mucosal epithelial injury was obvious in small intestine even at the 0th h, and it became more serious at the 1^stand the 3^rd h. The tissue restitution was also found after 3 h, though the injury was still serious. Most of the injured mucosal restitution was established after 6 h and completed in 24 h. Two distinct models of cell deathapoptosis and necrosis-were involved in the destruction of rat intestinal epithelial cells. The number of goblet cells on intestinal mucosa was reduced significantly from 0 to 24 h (the number from 243±13 to 157±9 for ileum, 310±19 to 248±18 for colon; r= -0.910 and -0.437 respectively, all P〈0.001), which was the same with the large intestine, but the grade of injury was lighter with the values of mucosal damage index in 3 h for jejunum, ileum, and colon being 2.8, 2.6, 1.2, respectively. The mucosal thickness and the height of villi in jejunum and ileum diminished in 1 h (the average height decreased from 309±24 to 204±23 pm and 271±31 to 231±28 pm, r = -0.758 and -0.659, all P〈0.001, the thickness from 547±23 to 418±28μm and 483±45 to 364±35μm, r= -0.898 and -0.829, all P〈0.001), but there was no statistical difference in the colon (F= 0.296, P = 0.934). Compared with control group, the urine L/M ratio and the blood LPS concentration in the experimental groups raised significantly, reaching the peak in 3-6 h (L/M: control vs 3 h vs6 h was 0.029±0.09 vs 0.063±0.012 vs 0.078±0.021, r = -0.786, P〈0.001; LPS: control vs3 h vs6 h was 0.09±0.021 vs 0.063±0.012 vs0.25±0.023, r=- -0.623, P〈0.001), and it kept increasing in 24 h. CONCLUSION: The gut barrier of the rats was seriously damaged at the early phase of ischemic reperfusion injury after hemorrhagic shock, which included the injury and atrophy in intestinal mucosa and the increasing of intestinal permeability. Simultaneously, the intestinal mucosa also showed its great repairing potentiality, such as the improvement of the intestinal permeability and the recovery of the morphology at different phases after ischemic reperfusion injury. The restitution of gut barrier function was obviously slower than that of the morphology and there was no direct correlation between them. Compared with the small intestine, the large intestine had stronger potentiality against injury. The reduction of the amount of intestinal goblet cells by injury did not influence the ability of intestinal mucosal restitution at a certain extent and it appeared to be intimately involved in the restitution of the epithelium. 展开更多
关键词 Gut barrier Hemorrhagic shock RESTITUTION
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Effect of herbal medicine Juzentaihoto on hepatic and intestinal heat shock gene expression requires intestinal microflora in mouse 被引量:5
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作者 Miho Kato Atsushi Ishige +7 位作者 Naoko Anjiki Masahiro Yamamoto Yoshifumi Irie Mitsue Taniyama Ryoko Kibe Junichiro Oka Yoshimi Benno Kenji Watanabe 《World Journal of Gastroenterology》 SCIE CAS CSCD 2007年第16期2289-2297,共9页
AIM: To evaluate the role of intestinal microflora in the effects of multi-herbal medicine on gene expression in the gut and liver. METHODS: The multi-herbal medicine Juzentaihoto (JTX) was administered to five ge... AIM: To evaluate the role of intestinal microflora in the effects of multi-herbal medicine on gene expression in the gut and liver. METHODS: The multi-herbal medicine Juzentaihoto (JTX) was administered to five germ-free mice and regular mice for 2 wk. Among the results of the comprehensive gene chip analysis of the intestine and liver, we featured heat shock proteins (HSPs) 70 and 105 because their gene expression changed only in the presence of microflora. Real-time RT-PCR was performed to confirm the expression levels of these HSP genes. To determine whether JTX acts directly on the HSP genes, sodium arsenite (SA) was used to induce the heat shock proteins directly. To examine the change of the intestinal microflora with administration of JTX, the terminal restriction fragment polymorphism (T-RFLP) method was used. To identify the changed bacteria, DNA sequencing was performed.documented by gene chip and real-time RT-PCR, changed with the administration of JTX in the regular mice but not in the germ-free mice. JTX did not suppress the direct induction of the HSPs by SA. T-RFLP suggested that JTX decreased unculturable bacteria and increased Lactobacillus johnsoni. These data suggested that JTX changed the intestinal microflora which, in turn, changed HSP gene expression.CONCLUSION: Intestinal microflora affects multi-herbal product JTX on the gene expression in the gut and liver. 展开更多
关键词 Herbal medicine Juzentaihoto Intestinal microflora Terminal restriction fragment length polymorphism Heat shock protein
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Unrecognized pylephlebitis causing life-threatening septic shock: A case report 被引量:1
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作者 Matthew Wireko Philip A Berry +1 位作者 John Brennan Rakesh Aga 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第4期614-615,共2页
A man who developed profound septic shock was treated for Escherichia colisepsis of unknown origin. Following stabilisation, a diagnosis of pylephlebitis (infection and thrombosis in the portal vein) was made at compu... A man who developed profound septic shock was treated for Escherichia colisepsis of unknown origin. Following stabilisation, a diagnosis of pylephlebitis (infection and thrombosis in the portal vein) was made at computed tomography. A review of the condition, its primary causes,typical features, investigation and management was presented. 展开更多
关键词 PYLEPHLEBITIS Septic shock
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Protective effect of Astragalus membranaceus on intestinal mucosa reperfusion injury after hemorrhagic shock in rats 被引量:9
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作者 Zi-Qing Hei He-Qing Huang +2 位作者 Jing-Jun Zhang Bing-Xue Chen Xiao-Yun Li 《World Journal of Gastroenterology》 SCIE CAS CSCD 2005年第32期4986-4991,共6页
AIM: To study the protective effect of Astragalus rnernbranaceus on intestinal mucosa reperfusion injury and its mechanism after hemorrhagic shock in rats. METHODS: A total of 32 SD rats were randomly divided into f... AIM: To study the protective effect of Astragalus rnernbranaceus on intestinal mucosa reperfusion injury and its mechanism after hemorrhagic shock in rats. METHODS: A total of 32 SD rats were randomly divided into four groups (n = 8, each group): normal group, model group, low dosage group (treated with 10 g/kg Astragalus membranaceus) and high dosage group (treated with 20 g/kg Astragalus membranaceus). The model of hemorrhagic shock for 60 min and reperfusion for 90 min was established. Therapeutic solution (3 mL) was administrated before reperfusion. At the end of the study, the observed intestinal pathology was analyzed. The blood concentrations of lactic acid (LD), nitric oxide (NO), endothelin-1 (ET-1), malondialdehyde (MDA) and the activity of superoxide dismutase (SOD), glutathione peroxidase (GSH-PX) in intestinal mucosa were determined. RESULTS: The intestinal mucosa pathology showed severe damage in model group and low dosage group, slight damage in high dosage group and no obvious damage in normal group. The Chiu's score in low dose group and high dose group was significantly lower than that in model group. The content of MDA in model group was higher than that in low and high dose groups, while that in high dose group was almost the same as in normal group. The activity of SOD and GSH-PX was the lowest in model group and significantly higher in high dose group than in normal and low dose groups. The concentrations of LD and ET-1 in model group were the highest. The concentrations of NO in model group and low dose group were significantly lower than those in high dose group and normal group. CONCLUSION: High dose Astraga/us membranaeus has much better protective effect on hemorrhagic shockreperfusion injury of intestinal mucosa than low dose Astragalus membranaceus. The mechanism may be that Astragalus membranaceus can improve antioxidative effect and regulate NO/ET level during hemorrhagic reperfusion. 展开更多
关键词 Hemorrhage shock Intestinal reperfusion injury Astragalus membranaceus
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Clinical significance of heat shock protein 10 in large bowel carcinoma
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作者 Junhui Chen Liming Chen +3 位作者 Shaobin Wang Jiexiong Huang Qiancheng Oiu Liyan Xu 《The Chinese-German Journal of Clinical Oncology》 CAS 2007年第4期334-338,共5页
Objective: To investigate the expression of heat shock protein 10 (HSPIO) during genesis and development of large bowel carcinoma and discuss the clinical significance about its expression. Methods: The expression... Objective: To investigate the expression of heat shock protein 10 (HSPIO) during genesis and development of large bowel carcinoma and discuss the clinical significance about its expression. Methods: The expression of HSPIO was observed in specimens from normal colonic mucosa (NC), colorectal adenomas (CA) and colorectal adenocarcinomas (CAC) by immunohistochemistry EnVisionTM. Its correlations to clinicopathologic features, as well as to postoperative survival time of large bowel carcinoma patients were analyzed. Results: The expression of HSPIO was common in normal colonic mucosa, colorectal adenomas and adenocarcinomas and more intensive in colorectal adenomas and adenocarcinomas than that in normal colonic mucosa (P 〈 0.001). The positive expression of HSPIO had no correlation to clinicopathologic features, including age, gender, primary tumor, infiltrating of regional lymph node, metastasis, clinical stage and histopathology of large bowel carcinoma patients, as well as to their postoperative survival time. Conclusion: HSPIO was overexpressed in the early stage of colorectal adenocarcinoma suggesting that it could serve as an index for early diagnosis of large bowl carcinoma. The positive expression of HSPIO had no correlation to clinicopathologic features or postoperative survival time of large bowel carcinoma patients. 展开更多
关键词 heat shock protein 10 colorectal neoplasm IMMUNOHISTOCHEMISTRY
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Experimental studies on the treatment and pathological basis of combined radiation and burn injury 被引量:1
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作者 程天民 陈宗荣 +3 位作者 阎永堂 冉新泽 粟永萍 艾国平 《Chinese Medical Journal》 SCIE CAS CSCD 2002年第12期1763-1766,共4页
OBJECTIVE: To investigate therapeutics for and the pathological basis of combined radiation and burn injuries. METHODS: Combined radiation and burn injuries on mice and rats were inflicted by gamma ray irradiation fro... OBJECTIVE: To investigate therapeutics for and the pathological basis of combined radiation and burn injuries. METHODS: Combined radiation and burn injuries on mice and rats were inflicted by gamma ray irradiation from a (60)Co source and thermal radiation from a 5 kW bromotungsten lamp. RESULTS: The dysfunction of myocardium played an important role in the development of early stage shock. Transfusion of irradiated (in vitro, 20 Gy) or stored (4 degrees C, 7 days) blood after irradiation was done to promote the success of allo-transplantation of bone marrow. Decrease of IL-4 mRNA expression was the molecular basis of depression of intestinal mucosa immune and intervention of IL-4 showed an antagonistic effect on enterogenic infection. A new lipid component extracted from burn eschar was documented for the first time and its toxic effects were elucidated. The survival rate of alloskin grafts after removal of burn eschar from the recipient animals was obviously increased in combined injury due to reduction of immune rejection activity by the radiation effect. In contrast, in animal models with simple burn, the alloskin grafts were all rejected within ten days after the procedure. A successful therapeutic result (survival rate: 92% for 30 days and 67% for 100 days) was obtained by comprehensive management of treated animals, while the untreated control animals all died within 3 - 7 days after injury. CONCLUSION: The pathogenesis of injury caused by simultaneous radiation and burn is extremely complicated and the treatment is very difficult. A comprehensive management program consisting of several therapeutic measures aimed at key links of the pathogenesis may achieve significantly improved results. 展开更多
关键词 ANIMALS BURNS Calcium Heart HEMATOPOIESIS Mice Radiation Injuries RATS Rats Wistar Research Support Non-U.S. Gov't
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