乙醇对血钾浓度的影响及其机制探讨

发布时间：2018-03-11 04:08

  本文选题：乙醇　切入点：血清钾离子　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:在法医实践中,因酒后自制力失控、乙醇对机体的损伤等原因造成的外伤、意外、交通事故甚至死亡等案件逐年增多。有临床研究发现过量饮酒所致的酒精中毒患者时常出现电解质紊乱,特别是血清钾离子降低,表现为肌无力和发作性软瘫,食欲缺乏,腹胀,恶心和便秘;严重缺钾者可引起麻痹性肠梗阻,甚至导致死亡。本室在前期观察人饮酒后对电解质、血糖、血脂、凝血功能、肝功能影响时发现,几乎所有饮酒者都有血清钾降低的趋势。目前,饮酒后血钾降低的变化规律以及乙醇导致血清钾离子降低的机制前尚不清楚。本研究拟从探究乙醇导致血清钾离子的降低现象为切入点,从以下两个方面研究乙醇对钾离子的作用及其机制:(1)收集急慢性饮酒人体标本,观察血清钾离子的变化规律;(2)建立急慢性饮酒大鼠模型,探讨血清钾离子降低的机制。方法:1观察人体急性饮酒后血生化指标的变化1.1人体标本采集征集急性饮酒志愿者22名,年龄在20-50岁之间,征集要求:(1)男性;(2)无基础疾病;(3)未服用特殊药物(影响电解质、血压、血糖等的药物);(4)如实填写知情同意书。1.2试验分组及方法志愿者随机分为两组,其中低剂量组10人,饮酒(饮用白酒56%v/v)100ml,饮酒后1h采血,高剂量组12人,饮酒150ml,饮酒后1.5h采血。对各志愿者饮酒前和饮酒后的血乙醇浓度、电解质、凝血功能、肝功能、乙醇脱氢酶(ADH)、乙醛脱氢酶(ALDH)进行监测,以观察急性饮酒对上述血生化指标的影响。2观察急慢性饮酒后人体血清钾离子的变化规律2.1急性饮酒人体标本采集及分组:征集急性饮酒志愿者5名,志愿者要求:(1)男性;(2)年龄在20-30岁之间,其他要求同前。因实验数据均为志愿者饮酒前后自身的对照,在统计学上所收集案例数量能够满足统计学要求。然后,对各志愿者饮酒(饮用白酒56%v/v)前和饮酒后0.5 h、1 h、2 h、3 h的血乙醇浓度和血清钾离子(Serum potassium,SP)进行监测,以观察急性饮酒后SP的变化规律。2.2慢性饮酒人体标本采集及分组:征集慢性中重度饮酒和不饮酒或轻度饮酒志愿者60名,志愿者要求:(1)男性;(2)年龄在20-50岁之间;其他要求同前。试验分组:分为20-30岁组、30-40岁组、40-50岁组,每组20人;每组中慢性中重度饮酒者10人,不饮酒或轻度饮酒者10人。抽血检测各志愿者SP,以观察慢性中重度饮酒对SP的影响。2.3采血方式:抽血前安静休息15分钟,肘正中静脉穿刺抽血。2.4检测:采用离子选择电极法检测SP;采用顶空气相色谱法检测BAC。3急慢性饮酒动物模型建立及实验分组3.1急性饮酒动物模型建立及实验分组:(1)对照组(n=36):随机分为Control组、0.5 h、1 h、1.5 h、2 h、2.5 h组,每组6只。Control组用蒸馏水灌胃(1.2 ml/100 g)后,于0.5 h、1 h、1.5 h、2 h、2.5 h内眦静脉取血测定血清钾离子浓度;(2)急性饮酒组(n=30):随机分为0.5 h、1 h、1.5 h、2 h、2.5 h组,每组6只。给予饮用白酒(56%v/v)灌胃(1.2 ml/100g)制备急性饮酒组模型。各组分别于灌胃后0.5 h、1 h、1.5 h、2 h、2.5 h内眦取血测定血乙醇浓度和血清钾离子浓度;(3)钠-钾ATP酶抑制剂组(以下简称抑制剂组)(n=18):随机分为1 h、1.5 h、2 h组,每组6只。腹腔注射给予钠-钾ATP酶抑制剂哇巴因溶液(Oua)(60μg/100 g)进行干预。各组分别于腹腔注射Oua后1 h、1.5 h、2 h内眦取血测定血清钾离子浓度;(4)抑制剂+饮酒组(n=18),随机分为1 h、1.5 h、2 h组,每组6只。在腹腔注射给予Oua(60μg/100 g)后,随即给予饮用白酒(56%v/v)灌胃(1.2 ml/100 g)。各组分别于灌胃后1 h、1.5 h、2 h进行内眦取血测定血乙醇浓度和血清钾离子浓度。3.2慢性饮酒动物模型建立及实验分组:(1)慢性饮酒组(n=18):随机分为1 w、2 w、4 w组,每组6只。分别给予饮用白酒(56%v/v)灌胃(1.2 ml/100 g/d)1 w、2 w、4 w制备慢性饮酒组模型。各组分别于末次灌胃后12 h进行内眦取血测定血钾含量;(2)慢性+急性饮酒组(n=18):随机分为1 w、2 w、4 w组,每组6只。各组分别于末次灌胃后12 h再次进行急性饮用白酒(56%v/v)灌胃(1.2 ml/100 g),并于灌胃后1.5h进行内眦取血测定血乙醇浓度和血清钾离子浓度。3.3检测:采用离子选择电极法检测SP;采用顶空气相色谱法检测BAC。结果:1人体急性饮酒后血生化指标的变化:急性饮酒后血钠、血氯、血钙、血镁、血磷、ADH、ALDH含量,凝血功能,肝功能,与饮酒前均无显著性差异(P0.05),而血钾比饮酒前显著降低(P0.05)。2饮酒对人体血清钾离子的影响:(1)急性饮酒志愿者0.5 h、1 h、2 h的SP均比饮酒前显著降低(P0.05)。饮酒后3 h的SP与饮酒前比无显著性差异(P0.05)。饮酒后3 h内的BAC与SP的Pearson相关系数为-0.67;(2)慢性中重度饮酒和不饮酒或轻度饮酒志愿者,各年龄段组内组间SP均无显著性差异(P0.05);3饮酒对大鼠血清钾离子的影响:(1)大鼠急性饮酒后0.5h、1 h、1.5 h、2 h组SP比对照组显著降低(P0.05),2.5 h组SP与对照组相比无显著性差异(P0.05)。BAC与SP的Pearson相关系数为-0.68;(2)抑制剂组大鼠各时间点SP比对照组显著升高(P0.05);(3)抑制剂+急性饮酒组大鼠SP比急性饮酒组显著升高(P0.05),但较抑制剂组显著降低(P0.05);(4)大鼠慢性饮酒1 w、2 w、4 w对SP无显著影响(P0.05);(5)大鼠慢性+急性饮酒后1 w、2 w、4 w组SP比对照组显著降低(P0.05),与急性饮酒1.5h组相比无显著变化。上述结果提示,钠-钾ATP酶抑制剂拮抗了急性饮酒所致钾离子的降低。结论:1饮酒后人体血清钾浓度短暂降低为急性乙醇作用所致,并随乙醇浓度呈现规律性变化,而慢性饮酒对血清钾浓度无影响。2急性乙醇作用所致血清钾浓度降低与细胞内外钾离子转运功能有关。
[Abstract]:Objective: in forensic practice, drunken self-control is out of control, causing ethanol injury to the body due to trauma, accidents, traffic accidents and even death cases increased year by year. Clinical studies have found that alcohol poisoning caused by excessive drinking often occurs in electrolyte disorder, especially serum potassium decreased, showed weakness and seizures soft paralysis, loss of appetite, abdominal distension, nausea and constipation; severe potassium deficiency can cause paralytic ileus, and even lead to death. The room in the early observation of drinking on blood glucose, blood lipid, electrolyte, blood coagulation function, found that the influence of liver function, almost all drinkers have decreased serum potassium current. Changes of serum potassium, decreased after drinking and ethanol induced mechanism of serum potassium decreased before is not clear. This study intends to explore ethanol leads to the decrease of serum potassium phenomenon as the breakthrough point, from the following Two aspects of ethanol on the potassium ion effect and its mechanism: (1) from acute and chronic alcohol consumption in human specimens, observe the changes of serum potassium ion; (2) the establishment of acute and chronic drinking rat model, and explore the mechanism of serum potassium decreased. Methods: the changes of biochemical indexes of 1 acute human blood after 1.1 drinks the human body specimens collection of acute alcohol intake of 22 volunteers, collecting requirements at the age of 20-50, (1): male; (2) basic diseases; (3) did not take special drugs (blood pressure, blood glucose and electrolyte effects, drugs); (4) fill in the informed consent of volunteers.1.2 test group and method were randomly divided into two groups, including low dose group (10 people, drinking liquor drinking 56%v/v 100ml, 1H) after drinking blood, the high dose group of 12 people, drinking 150ml, after drinking 1.5h blood. The blood alcohol concentration, the volunteers before and after drinking alcohol electrolytes, coagulation function, liver function, Alcohol dehydrogenase (ADH), aldehyde dehydrogenase (ALDH) were monitored to observe the acute effects of alcohol on the blood biochemical.2 observation of human serum potassium changes after acute and chronic alcohol drinking 2.1 acute human specimen collection and grouping: for acute alcohol 5 volunteers, volunteer requirements: (1) (2 men; at the age of 20-30), with other requirements. Because the experimental data are in its own volunteers before and after drinking, collected the number of cases can meet the statistical requirements in statistics. Then, the volunteers (alcohol drinking liquor 56%v/v) before and after drinking 0.5 h, 1 h, 2 h, and the blood alcohol concentration the serum potassium ion of 3 h (Serum potassium SP) were monitored to observe the acute SP after drinking.2.2 changes of chronic alcohol consumption of human specimen collection and grouping: for chronic heavy drinking and non drinking or mild drinking 60 volunteers, volunteer 鑰呰�佹保�

本文编号：1596491