【作者】 张晓明；

【导师】 张凯伦；

【作者基本信息】 华中科技大学 ， 外科学， 2007， 博士

【摘要】 第一部分无血预充兔体外循环模型的建立目的探索建立无血预充兔体外循环模型的方法,为进一步的实验研究打下基础。方法3O只新西兰兔,采用右心房引流,右锁骨下动脉灌注的方法,建立兔体外循环模型,并监测转流前、中、后动脉血气的变化。结果成功建立起无血预充兔体外循环模型,动脉血气各项指标结果满意。结论证明建立无血预充兔体外循环模型是可行的。第二部分四君子汤和奥美拉唑对兔体外循环模型胃肠道保护作用的研究目的研究四君子汤和奥美拉唑对兔体外循环模型胃肠道的保护作用,为临床应用打下基础。方法建立兔体外循环模型,给予不同的治疗方法后,在体外循环不同时间点检测胃pHi、血浆内毒素(LPS)、二胺氧化酶(DAO)、肿瘤坏死因子-α(TNF-α)的水平变化,并行实验动物胃组织切片检查,以确定体外循环对胃肠道功能的影响以及不同药物运用对胃肠道的保护作用。结果各组检测指标体外循环后各时间点与体外循环前都有明显差异;各治疗组的胃pHi均高于对照组,而四君子汤和奥美拉唑联合用药治疗组的胃pHi又高于单独用药治疗组;各治疗组的LPS、DAO、TNF-α水平均低于对照组,而四君子汤和奥美拉唑联合用药治疗组的各指标水平又低于单独用药治疗组;实验动物组织切片检查显示联合治疗组的胃粘膜损伤明显轻于对照组。结论体外循环对胃肠功能有明显的影响,四君子汤与奥美拉唑单独运用对体外循环时的胃肠道功能均有保护作用,四君子汤与奥美拉唑联合用药的保护作用更加明显,具有良好的临床应用前景。第三部分四君子汤联合奥美拉唑对体外循环胃肠道保护作用的临床研究目的研究四君子汤联合奥美拉唑对心脏手术体外循环中胃肠道的保护作用。方法60例体外循环下心内直视手术成人患者,随机分为4组:治疗1组(B组)在CPB预充液中加入奥美拉唑40mg,术后12h后再静脉给予奥美拉唑40mg;治疗2组(C组)手术前一天分两次给予四君子汤(含生药1g/ml)200ml,术后12小时通过胃管再给予100ml;治疗3组(D组)按上述方法联合用药;对照组给予等量生理盐水。在体外循环不同时间点检测胃pHi、血浆内毒素(LPS)、二胺氧化酶(DAO)、肿瘤坏死因子-α(TNF-α)的水平变化,并进行术后临床症状的观察,以确定不同药物运用对胃肠道的保护作用。结果各治疗组的胃pHi均高于对照组,而四君子汤和奥美拉唑联合用药治疗组的胃pHi又高于单独用药治疗组;各治疗组的LPS、DAO、TNF-α水平均低于对照组,而四君子汤和奥美拉唑联合用药治疗组的各指标水平又低于单独用药治疗组;各治疗组出现临床症状患者明显少于对照组;结论在心脏手术体外循环中四君子汤与奥美拉唑联合用药可明显减轻体外循环对胃肠道的损伤作用,具有良好的应用前景。更多还原

【Abstract】 PartⅠEstablishment of a Rabbit Model of Cardiopulmonary Bypass Flushed without BloodObjective To establish a rabbit model of the cardiopulmonary bypass (CPB) flushed without blood.Method Thirty New Zealand rabbits were included in this experiment. The CPB procedure was established via right subclavian artery and right atrium cannulation. The blood-gas parameters were examined before and after CPB.Results The rabbit cardiopulmonary bypass model was established successfully. The results of arterial blood gas analysis were satisfactory. No hemorrhage and operation death occurred in this experiment.Conclusion A rabbit model of cardiopulmonary bypass flushed without blood has been established and showed to be feasible for related pathophysiological research work. PartⅡExperimental Study on the Protection of Sijunzi Decoction and Omeprazole for the Gastroenteric Function of the Rabbit Cardiopulmonary Bypass ModelsObjective To investigate the protection of sijunzi decoction and omeprazole for the gastroenteric function of the rabbit cardiopulmonary bypass models.Methods Rabbit cardiopulmonary bypass models flushed without blood were established and treated with sijunzi decoction and omeprazole. The levels of pHi, LPS, DAO, TNF-αwere detected in different time of cardiopulmonary bypass and tissue sections were observed to research the influence of cardiopulmonary bypass on the gastroenteric function and the protection of different treatments.Results The indicators after cardiopulmonary bypass showed conspicuous difference from the preoperative’s. The pHi levels of all treated groups were higher than control group and the levels of LPS, DAO and TNF-αwere lower than control group. The tissue sections showed more damagement of gastrointestinal mucosa in control group.Conclusion Cardiopulmonary bypass did damage to gastroenteric function. The medication of sijunzi decoction and omeprazole respectively showed protection for the gastroenteric function in cardiopulmonary bypass and the medication of sijunzi decoction with omeprazole together showed more significant protection. PartⅢClinical Research on the Gastroenteric Protection of the Medication of Sijunzi Decoction with Omeprazole together in Cardiopulmonary BypassObjective To investigate the the gastroenteric protection of the medication of sijunzi decoction with omeprazole together in cardiopulmonary bypass.Methods Sixty adult patients were randomized equally into 4 groups. The levels of pHi, LPS, DAO, TNF-αwere detected in different time of cardiopulmonary bypass and clinical symptoms were observed to research the gastroenteric protection of different treatments.Results The pHi levels of all treated groups were higher than control group and the levels of LPS, DAO and TNF-αwere lower than control group. The clinical symptoms were more frequent in control group.Conclusion The medication of sijunzi decoction with omeprazole together showed significant gastroenteric protection in cardiopulmonary bypass.更多还原