丹酚酸A对肾盂内高压合并感染致急性感染性休克的作用

发布时间：2018-07-03 14:47

  本文选题：丹酚酸A + 尿源性脓毒血症　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:通过构建肾盂内高压合并感染致急性感染性休克兔模型,模拟临床腔内碎石术后急性感染性休克过程,研究丹酚酸A(Sal.A)这一具有显著的抗氧化作用的水溶性酚酸类化合物能否改善急性感染性休克的预后。方法:动物实验:将新西兰兔随机分为ABCD四组,分别将2ml/Kg体重生理盐水、2ml/Kg体重6*10^8cfu/L标准大肠杆菌、2ml/Kg体重9*10^8cfu/L标准大肠杆菌、2ml/Kg体重12*10^8cfu/L注入兔左侧肾盂,分别监测实验过程平均动脉压(MAP)的变化,根据结果选择D组作为急性感染性休克模型。随后将新西兰兔随机分组为空白对照组(E0)、标准休克模型组(E1)、丹酚酸A干预组(E2),按2ml/Kg体重向E0组肾盂注入生理盐水,向E1、E2组肾盂注入12*10^8cfu/L标准大肠杆菌溶液,并在术后0.5h按10mg/kg体重向E2静脉注射Sal.A,在E0、E1组同时间点注射等量生理盐水,术后检测兔血清晚期氧化蛋白(AOPP),监测平均动脉压(MAP)并记录生存时间。结果:取术后2、3、4小时平均MAP作为基础MAP,与之相比,A组、B组、C组术后6小时内平均动脉压均无明显差异。D组在术后6小时平均动脉压明显下降。D组术后3小时平均动脉压(68.8±9.2mmHg)、4小时(64.6±7.9mmHg)与基础MAP(69.9±6.7mmHg)相比无显著性差异(P0.05),6小时平均动脉压(61.4±11.3mmHg)与基础MAP相比明显下降(P0.05),8小时平均动脉压(52.8±8.3mmHg)与之相比有显著性下降(P0.01)。将术后MAP小于0.7*基础MAP的时间点作为休克时间,D组休克时间为8.3±0.8小时,死亡时间为11.1±1.1小时。因此,我们将D组作为肾盂内高压伴感染性休克的标准模型。E0组(空白对照组)术后血压无明显下降,未出现休克,24小时100%存活。E1组(休克标准对照组)6小时平均动脉压(61.6±10.3mmHg)与基础MAP(68.9±5.3mmHg)相比明显下降(P0.05),在术后8.7±0.8小时出现休克,术后11.1±0.9小时死亡,E2组(药物干预组)术后11小时MAP(46.8±26.6mmHg)与基础MAP(62.8±16.5mmHg)相比明显下降(P0.05),在11.9±1.1小时出现休克,于13.6±1.7小时死亡。E2组的休克时间较E1组显著延后(P0.05),死亡时间亦明显延后(P0.05),提示进行早期注射丹酚酸A抗氧化治疗在某种程度上能够延后休克及死亡的发生时间。E0组的AOPP在术后8小时内基本保持稳定。E1组的AOPP在术后2小时较0小时有轻度升高,自手术4小时以后随时间呈明显下降趋势(P0.05)。E2组的AOPP在术后2小时较0小时有轻度降低,4小时以后呈现轻度下降趋势(P0.05),直至术后8小时较0小时方有显著性降低。以AOPP血清白蛋白(Alb)校正休克过程中蛋白自血管内向组织间隙移动对血清AOPP的影响,发现E1组AOPP/Alb比值在术后较E2组呈显著升高趋势。结论从本研究的平均动脉压变化及生存曲线上来看,用合适剂量的丹酚酸A早期干预可以延后休克模型的休克发生及死亡时间,在一定程度上有改善预后的作用。从AOPP及AOPP/Alb比值变化来看,丹酚酸A早期干预能够降低感染性休克过程中的氧化应激水平,减少氧化损伤。
[Abstract]:Objective: to simulate the process of acute septic shock after endovascular lithotripsy by constructing a rabbit model of acute septic shock induced by intrapelvic hypertension and infection. To study whether Salvianolic acid A (Sal.A), a water-soluble phenolic acid compound with significant antioxidant effect, can improve the prognosis of acute septic shock. Methods: animal experiments: new Zealand rabbits were randomly divided into four groups of ABCD, and 2 ml / kg body weight of normal saline 2 ml / kg / kg weight of 610 ^ 8 cfur / L standard Escherichia coli 2 ml / kg body weight 9% 10 ^ 8 cfur / L standard Escherichia coli 2 ml / kg / kg weight of 1210 ^ 8 cfur / L was injected into the left renal pelvis of rabbits. The changes of mean arterial pressure (map) were monitored, and group D was selected as the model of acute septic shock according to the results. Then New Zealand rabbits were randomly divided into blank control group (E0), standard shock model group (E1) and Salvianolic acid A intervention group (E2). Normal saline was injected into the renal pelvis of E0 group according to the weight of 2 ml / kg, and 1210 ^ 8 cful standard Escherichia coli solution was injected into the renal pelvis of E1E 2 group. At 0.5 h after operation, Sal.A was injected into E2 according to 10mg/kg body weight, and saline was injected into E0E 1 group at the same time point. Serum late oxidizing protein (AOPP) was detected, mean arterial pressure (map) was monitored and survival time was recorded. Results: the mean map of 2 hours and 3 hours after operation was taken as the basic MAP.Compared with the mean arterial pressure in group A and group B, there was no significant difference in the mean arterial pressure within 6 hours after operation. The mean arterial pressure in group D decreased significantly at 6 hours after operation. The mean arterial pressure in group D decreased significantly at 3 hours after operation. There was no significant difference in arterial pressure (68.8 卤9.2 mmHg) for 4 hours (64.6 卤7.9 mmHg) and basic map (69.9 卤6.7 mmHg) (P0.05). The mean arterial pressure (61.4 卤11.3 mmHg) in 6 hours was significantly lower than that in basal map (P0.05). The mean arterial pressure (52.8 卤8.3 mmHg) in 8 hours was significantly lower than that in basal map (P0.01). The shock time of group D was 8.3 卤0.8 hours and the time of death was 11.1 卤1.1 hours. Therefore, we treated group D as the standard model of intrapelvic hypertension with septic shock. Group E0 (blank control group) showed no significant decrease in blood pressure after operation. The mean arterial pressure at 6 hours (61.6 卤10.3mmHg) and basal map (68.9 卤5.3mmHg) decreased significantly in the 100% survival group (shock standard control group) without shock at 24 hours (P0.05), and shock occurred at 8.7 卤0.8 hours postoperatively. Map (46.8 卤26.6mmHg) decreased significantly in E _ 2 group at 11.1 卤0.9 hours postoperatively compared with baseline map (62.8 卤16.5 mmHg) (P0.05), and shock occurred at 11.9 卤1.1 hours. At 13.6 卤1.7 hours, the shock time of E2 group was significantly delayed than that of E1 group (P0.05), and the time of death was also significantly delayed (P0.05), suggesting that early anti-oxidation therapy of Salvianolic acid A could delay shock and death to some extent in E0 group. AOPP in group 1 remained stable within 8 hours after operation. AOPP increased slightly at 2 hours after operation compared with 0 hours after operation. AOPP in E2 group decreased slightly after 2 hours compared with 0 hours after operation (P0.05), then decreased slightly after 4 hours (P0.05), and decreased significantly at 8 hours after operation compared with 0 hours after operation (P0.05). AOPP / Alb ratio in E1 group was significantly higher than that in E2 group. Conclusion according to the change of mean arterial pressure and survival curve of this study, early intervention with appropriate dose of Salvianolic acid A can delay the onset and death time of shock in the model of shock, which can improve the prognosis to some extent. According to the changes of AOPP and AOPP / Alb ratio, early intervention of Salvianolic acid A can reduce oxidative stress and reduce oxidative damage during septic shock.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699
，

本文编号：2094008