【作者】 聂磊；

【导师】 张训臣；

【作者基本信息】 武汉大学 ， 外科学， 2004， 硕士

【摘要】 目的：探讨选择性消化道去污在大鼠重症急性胰腺炎模型中对细菌移位及炎症反应的影响。 方法：48只SD大鼠随机分为正常对照组(norm组)、假手术组(sham组)、重症急性胰腺炎组(SAP组)、选择性消化道去污+重症急性胰腺炎组(SDD组)。采用胰胆管逆行注射4％牛磺胆酸钠的方法，建立SAP大鼠模型；SDD组术前用三联抗生素灌胃三天(庆大霉素2万U+多粘菌素10万U+制霉菌素10万U，Q8h)。24h后处死，观察腹腔大致变化并对胰腺组织做病理学评分；对肠道细菌进行计数；取胰腺和胰外组织肺、肝、脾、肾标本做细菌培养；检测胰腺组织髓过氧化物酶(MPO)及门静脉内毒素(LPS)和体循环血浆肿瘤坏死因子(TNFα)的表达水平。 结果：SAP组和SDD组在诱导SAP后，出现明显的细菌移位，肠道细菌计数和MPO、LPS及TNFα浓度比norm组和sham组均显著性升高；但SDD组各脏器细菌培养阳性率和肠道细菌计数及MPO、LPS、TNFα浓度与SAP组比较均有明显下降；前者的胰腺组织病理学评分也有所降低。 结论：在SAP大鼠模型中选择性消化道去污清除肠道细菌可减少肠源性感染，从而减轻炎症反应。更多还原

【Abstract】 Objective: To explore the effect of selective digestive decontamination (SDD) to decrease bacterial translocation and relieve inflatmmatory response in sever acute pancreatitis (SAP) in rats.Methods: The Sprague-Dawley rats were divided randomly into norm group, sham-operated group, SAP group, SDD group. SAP was induced by intraductal injection of 4% sodium taurocholate. SDD group underwent bacterial decontamination through the administration of Gentamycin, Polymyxin and Nystatin during the 3 days prior to SAP induction. 24 hours after SAP induction, laparotomy was performed and samples for the bacterial culture of pancreas, lung, liver, spleen and kidney was obtained. Intestinal bacteria was counted. A point scoring system of histologicalal features was used to evaluate the severity of pancreatitis. The levels of blood endotoxin in portal vein and plasma TNF alpha in venae cavae were measured. Pancreatic myeloperoxidase (MPO) were detected at the same time.Results : In the SAP and SDD group, there was significant pancreatic and extrapancreatic infection 24 hours after induction of pancreatitis, counting of intestinal bacteria, plasma concentrations of endotoxin and TNF alpha were significantly higher than in norm group and sham-operated group controls. Compared with SAP group, all of above-mentioned indexes were decreased in SDD group.Conclusions The incidence of bacterial translocation and the severity of SAP can decreased by SDD prior to SAP induction.更多还原