【作者】 郝波；

【导师】 令狐恩强； 胡森；

【作者基本信息】 中国人民解放军军医进修学院 ， 消化内科， 2007， 硕士

【摘要】 目的：1、研究卡巴胆碱与烫伤大鼠休克早期胃排空率的量效关系，以确定卡巴胆碱在口服补液治疗中的应用剂量。2、通过对胃排空率测定及影响胃排空功能的因素如胃血流量、血浆胃动素、胃组织ATP酶活力及胃组织NO含量、NOS活力变化的观察，研究口服卡巴胆碱加口服补液盐（oral rehydration salt，ORS）能否促进烫伤大鼠休克早期胃肠运动，改善胃肠功能，提高口服复苏效果。方法：实验一：雄性Wistar大鼠随机分为假烫组、单烫组和口服卡巴胆碱组。除假烫组外，余大鼠均造成30％TBSA（total body surface area）Ⅲ度烫伤．大鼠造模后均立即给予0.1％酚红1.5ml灌胃针灌入（用时需加温至35℃），口服卡巴胆碱组于伤后30min按不同剂量（20ug／kg、40ug／kg、60ug／kg、80ug／kg、100ug／kg、120ug／kg）将卡巴胆碱经灌胃针灌入，观察2h后处死，测定酚红胃排空率及胃血流量。实验二：雄性Wistar大鼠随机分为假烫组、单烫组、烫伤后口服卡巴胆碱组，烫伤后口服ORS液、烫伤后口服卡巴胆碱+ORS液组。采用30％TBSAⅢ度烧伤大鼠模型，用酚红作为指示剂测定胃排空率。口服治疗于伤后半小时开始。卡巴胆碱按60μg／kg经灌胃针灌入，ORS液按Parkland公式(4ml.kg^-1.1％TBSA)半量分两次给予。分别于伤后2h、4h、6h测定胃血流量，随后处死大鼠，测定胃排空率、胃血流量、胃组织Na⁺-K⁺-ATPase、Ga²⁺-Mg²⁺-ATPase活力及一氧化氮（nitric oxide，NO）含量、一氧化氮合酶（nitric oxide synthases，NOS）活力。结果：1、烫伤后胃排空率及胃血流量均明显下降，给予不同剂量卡巴胆碱均能不同程度改善烫伤后明显下降的胃排空率及胃血流量，但以60ug／kg为明显，有统计学意义。2、伤后胃排空率、胃血流量和血浆胃动素水平明显下降，胃组织Na⁺-K⁺-ATPase、Ga²⁺-Mg²⁺-ATPase活力显著降低，胃组织NO含量明显增加，NOS活力明显上升。给予口服复苏均有不同程度改善，但以口服卡巴胆碱+ORS液改善明显，p＜0.01。结论：适当剂量卡巴胆碱联合ORS液用于口服复苏，可明显改善烫伤大鼠休克早期胃排空功能和胃血流量，促进胃肠运动，改善伤后能量代谢紊乱，提高复苏效果，并可能在一定程度上减少补液量。更多还原

【Abstract】 Objective1. To define the dosage of carbachol in oral resuscitation with oral rehydration salt（ORS） by investigating carbachol on gastric emptying rate and gastric blood flow in early shock stage of scalded rats.2. To investigate the effects of enteral carbachol plus ORS orally on function of gastric emptying in early shock stage of scald rats by assaying gastric emptying rate and determining some elements that can affect function of gastric emptying,such as gastric blood flow,plasma motilin,the activity of ATPase and NOS in gastric tissue and the content of NO in the gastric tissue.MethodsExperiment 1: Male wistar rats were randomly divided into shame control groups,scalded group and enteral carbachol group. About 30%TBSA of scalded injury on back of rats were induced with boiling water（100 ,15s） in all groups except the shame control group.Phenol red were taken orally after making modol of rats, carbachol of different dosage （20 ug/kg、 40ug/kg、 60ug/kg、 80ug/kg、 100 ug/kg、 120 ug/kg） was infused by an oral tube about thirty minutes after scalded. All rats were sacrificed at two hours post scalded to calculate the gastric emptying rate and determine the gastric blood flow.Experiment 2: The wistar rats were randomly divided into five groups: shame control, scalded without fluid resuscitation ,scalded resuscitation with oral rehydration salt, scalded resuscitation with the enteral carbachol, scalded resuscitation with enteral carbachol plus ORS group. Rats inflicted with 30 % TBSA degree full-thickness scalded injury on back. the phenol red was taken as the indicator to assay the gastric emptying rate. In all groups except the shamecontrol.ORS was given by oral tube according to semi-dosage of Parkland’ formula ( 4ml.kg^-1.1%TBSA ) at 30 min postinjury, and the dosage of carbachol was 60/kg.w . The rats were sacrificed at 2h,4h,6h post scalded to determine the gastric emptying rate after gastric blood flow was determined and to assay the value of plasma motilin, the activity of ATPase and NOS in gastric tissue and the content of NO in the gastric tussue. Result1. The gastric emptying rate and the gastric blood flow decreased apparently after scalded,which were promoted by carbachol of the defferent dosage taken orally and with 60ug/kg as the best dosage.2. In early shock stage after scalded, The gastric emptying rate, gastric blood flow and plasma motilin significantly decreased （p<0.01）,activity of ATPase in gastric tissue significantly descented ,the content of NO and activity of NOS in gastric tissue increased apparently, which they were progressed by the deferent oral resuscitation at deferent degree ,but action of the carbachol plus ORS was notible.ConclusionCarbachol of proper dosage plus ORS in oral resuscitation can improve the function of gastric emptying and gastric blood flow, promote motility of gastrointestinal tract in early shock stage in scalded rats,and improve therapeutic effect of ORS in the resuscitation of burns shock, and can reduce the quantity of ORS at some degree.更多还原