电针足三里穴对失血性休克大鼠植物神经和心脏功能的影响

发布时间：2018-04-25 00:16

  本文选题：电针 + 足三里穴　； 参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：目的：探讨电针对失血性休克延迟补液大鼠植物神经及心脏功能的影响。 方法：60只SD雄性大鼠（270±20g），随机分为5组：手术对照组（SHAM），失血性休克电针足三里组（EA），失血性休克假针组（SEA），失血性休克电针足三里复合延迟补液组（EA+DR），失血性休克假针复合延迟补液组（SEA+DR）,每组12只。SHAM组仅施行麻醉和股动、静脉置管术；其余各组按总血容量的45%放血、制作失血性休克模型。EA组在失血后立即针刺大鼠双侧“后三里”穴，并用电压强度为4V，电流脉冲为4Hz电针仪连续刺激40分钟；SEA组失血后即刻针刺后三里穴皮肤表皮层，只安装电针仪不进行电刺激以避免得气；EA+DR组大鼠在失血后立刻电针其双侧三里穴，在失血3h后于股静脉输液2倍失血量的乳酸林格氏液40分钟；SEA+DR组于在失血后即刻假刺后三里穴，失血后3h给予延迟补液治疗。各组动物测定失血前和失血后3h、6h的平均动脉压（MAP）以及其心率变异性（HRV）；同时抽取血样本检测肾上腺素（EPI）、乙酰胆碱（ACH）含量和心肌肌酸激酶同工酶（CK-MB）活性；并将处死动物后获取的心脏组织用于检测casepase-3蛋白活性及心肌细胞TUNEL阳性率。 结果：1、失血后各组大鼠MAP均比失血前显著降低,休克后3小时EA+DR组MAP显著高于SEA组和SEA+DR组（P均0.05）；失血6h后EA+DR组MAP显著高于EA组和SEA组（P0.05）；EA+DR组和SEA+DR两组大鼠失血6小时后平均动脉压未见显著性差异（P0.05）；2、与SHAM组比较失血6h后EA组、SEA组、SEA+DR组大鼠的心肌细胞casepase-3活性显著升高（P均0.05）；与SEA组比较EA组、EA+DR组和SEA+DR组casepase-3相对活性降低（P均0.05）；与SEA+DR组比较，EA+DR组大鼠失血6h后心肌组织细胞capase-3活性降低（0.301±0.022VS0.126±0.019），二者可见显著性差异（P0.05）。显微镜下观察到荧光标记的凋亡心肌细胞计数显示，失血6h后SHAM组心肌细胞TUNEL阳性率最低，EA+DR组TUNEL阳性率显著低于SEA+DR（P0.05）；3、对大鼠失血前、失血3h以及失血6h后心率变异性检测结果显示：与0h比较失血3h后各组LF显著增高（P0.05）；失血后3h与SEA组比较EA组和EA+DR组LF显著降低（40.3±2.3n.u VS29.6±2.1n.u,31.3±1.9n.u P0.05）；失血6h后EA+DR组LF低于SEA+DR组（11.4±1.8n.u VS17.8±2n.u），二者比较可见显著性差异（P0.05）。与失血前比较失血3h后各组HF显著降低（P0.05）；失血3h后EA组和EA+DR组HF显著高于SEA组（69.2±2.7n.u，68.7±2.1n.u VS52.1±3.2n.u P0.05）；失血6h后EA+DR组HF高于SEA+DR组（126.3±4.1n.u VS109.7±3.6n.u），二者可见显著性差异（P0.05）；4、在失血3h和6h后休克各组血浆肾上腺素与休克前相比显著升高（P0.05）；失血3h后EA组和EA+DR组大鼠血浆肾上腺素水平与SEA组比较显著降低(198.1±12.3ng/L，213.4±9.8ng/L VS269.5±19.6ng/L P0.05）；失血6h后与SEA+DR组比较EA+DR组肾上腺素含量显著升高(137.8±6.9ng/L VS98.6±7.4ng/L)，两组可见显著差异性（P0.05）；同时发现，失血3h和6h后各组大鼠血浆中乙酰胆碱含量较0h有显著变化（P0.05）；失血3h后EA组和EA+DR组ACH含量显著高于SEA组（P0.05）；失血6h后EA+DR组血浆ACH含量高于SEA+DR组(405±8.6pmol/L VS341±10.1pmol/L P0.05）。 结论：1、电针足三里穴可以有效地降低休克早期心率变异性HRV中低频成分LF，升高高频成分HF，有效地调节植物神经功能。降低了休克早期血浆中高肾上腺素水平，升高休克大鼠血浆副交感神经递质乙酰胆碱的浓度；2、电针足三里升高了休克大鼠的平均动脉压，降低了心肌细胞TUNEL阳性率和casepase-3蛋白的相对活性。提示电针足三里能有效地调节失血性休克大鼠植物神经功能，改善其心脏的泵血功能，降低心脏组织中凋亡细胞的表达。
[Abstract]:Objective: To explore the effect of Electroacupuncture on autonomic nerve and cardiac function in rats with delayed fluid resuscitation after hemorrhagic shock.
Methods: 60 SD male rats (270 + 20g) were randomly divided into 5 groups: operation control group (SHAM), hemorrhagic shock electroacupuncture Zusanli group (EA), hemorrhagic shock false needle group (SEA), hemorrhagic shock electroacupuncture Zusanli delayed fluid supplement group (EA+DR), hemorrhagic shock false needle compound delayed fluid supplement group (SEA+DR), each group of 12.SHAM groups only performed anaesthesia and femur. The other groups, according to the total blood volume of 45% of the blood, made the hemorrhagic shock model.EA group immediately after the loss of blood after the loss of the bilateral "Three Li" points, and the voltage intensity was 4V, the current pulse was stimulated by the 4Hz electroacupuncture for 40 minutes, and the SEA group immediately after the blood was needled at the skin layer of the three li point, only the electroacupuncture apparatus was installed. No electrical stimulation was carried out to avoid gas; the rats in group EA+DR were immediately Electroacupuncture with their bilateral three li points after losing blood and 40 minutes of llggr's liquid 2 times the amount of blood loss in the femoral vein after the loss of blood. Group SEA+DR was at the three li point after the loss of blood after the loss of blood, and after the loss of blood, 3h was given a delayed rehydration treatment. Each group of animals measured 3h, 6h after blood loss and after the loss of blood. The mean arterial pressure (MAP) and its heart rate variability (HRV) were used to detect the content of adrenaline (EPI), acetylcholine (ACH) and myocardial creatine kinase isoenzyme (CK-MB) activity, and the cardiac tissue obtained after the death of animals was used to detect the activity of casepase-3 protein and the positive rate of TUNEL in cardiac myocytes.
Results: 1, the MAP in each group was significantly lower than that before blood loss, and the MAP in group EA+DR was significantly higher than that in group SEA and SEA+DR (P 0.05) after 3 hours of shock, and MAP in EA+DR group after 6h was significantly higher than that in EA group and SEA group (P0.05), and the average arterial pressure was not significantly different after 6 hours of blood loss in the two groups and 2. Compared with group SEA, group SEA and group SEA+DR, the casepase-3 activity of myocardial cells in group SEA and SEA+DR was significantly higher (P 0.05). Compared with group SEA, casepase-3 relative activity in group EA+DR and SEA+DR groups decreased (P was 0.05). There was a significant difference (P0.05). Under the microscope, the apoptotic cardiomyocyte count showed that the TUNEL positive rate in SHAM group was the lowest, and the positive rate of TUNEL in EA+DR group was lower than that of SEA+DR (P0.05) in EA+DR group. 3, the results showed that before the loss of blood, the blood loss 3H and the heart rate variability after the loss of blood 6h showed that the blood loss 3H was compared with 0h. After blood loss, the LF of 3H and EA+DR in group EA and EA+DR group decreased significantly (40.3 + 2.3n.u VS29.6 + 2.1n.u, 31.3 + 1.9n.u P0.05), and the two groups were significantly lower than those in the EA group and EA+DR group. 5) after 3h, the HF in group EA and EA+DR group was significantly higher than that in group SEA (69.2 + 2.7n.u, 68.7 + 2.1n.u VS52.1 + 3.2n.u P0.05), and the EA+DR group was higher than that of the group (126.3 + 2.1n.u), and the two showed significant difference. 4, the plasma adrenaline was significantly higher than before the shock. The plasma adrenalin level in group EA and EA+DR group was significantly lower than that in group SEA after 3H loss (198.1 + 12.3ng/L, 213.4 + 9.8ng/L VS269.5 + 19.6ng/L P0.05), and the adrenaline content in the EA+DR group was significantly higher than that in the SEA+DR group (137.8 + 9.8ng/L). The content of acetylcholine in plasma of each group was significantly higher than that of 0h after 3H and 6h (P0.05), and the content of ACH in EA group and EA+DR group after 3H was significantly higher than that in group SEA (P0.05), and the plasma content of EA+DR group was higher than that of the group (405 +).
Conclusion: 1, electroacupuncture at Zusanli can effectively reduce the low frequency component LF in the early heart rate variability HRV, increase the high frequency component HF, effectively regulate the function of the plant nerve, reduce the level of high epinephrine in the plasma and increase the concentration of parasympathetic acetylcholine in plasma of shock rats, and 2, the increase of electroacupuncture at Zusanli. The mean arterial pressure of the shock rats decreased the positive rate of TUNEL and the relative activity of casepase-3 protein, suggesting that Zusanli can effectively regulate the function of the autonomic nervous system in the rats with hemorrhagic shock, improve the blood pump function of the heart and reduce the expression of apoptotic cells in the cardiac tissue.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R245

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