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目的观察颈交感神经阻滞(cervical sympathetic block,CSB)对严重烧伤大鼠肝脏功能与结构的保护作用,并对其可能保护机制进行探讨。方法将动物按随机数目表随机分为对照组、严重烧伤组和CSB治疗组,制作重度烧伤模型(TBSA20%Ⅲ度),CSB治疗组伤后以0.1%罗哌卡因行颈交感神经双侧阻滞。通过检测肝功能、肝组织抗氧化能力、Bcl-2表达以及肝组织病理改变判断CSB对肝脏的保护作用。通过检测监测血压变化及检测肝脏、下丘脑血流灌注量来推断其可能机制。结果 CSB组大鼠伤后血浆白蛋白下降及谷丙转氨酶上升不明显,1、3、5、7d时相点血浆白蛋白含量分别为(48.98±6.89)、(38.61±4.35)、(24.05±3.62)和(22.57±4.10)mmol/L,血浆ALT浓度分别为(48.15±7.37)、(58.21±5.43)、(62.07±8.16)、(56.87±5.88)IU/L,较烧伤组为好(P<0.01);CSB组肝组织总抗氧化能力分别为(3.16±0.17)、(2.88±0.15)、(2.71±0.16)、(2.61±0.58)U/mg,较烧伤组明显增强(P<0.01);CSB组大鼠伤后血压较为稳定,伤后1、3、5、7d时相点分别为(90.58±5.69)、(82.69±3.81)、(70.61±9.51)、(82.05±2.36)mmHg,与烧伤组相比差异显著(P<0.01);CSB组动物伤后脏器血流灌注较好,伤后即刻、1、3、5d时相点肝血流量分别为(0.302±0.041)、(0.284±0.024)、(0.16±0.023)、(0.256±0.03)ml/(min.g),下丘脑血流量分别为(1.013±0.113)、(0.721±0.110)、(0.944±0.438)、(0.765±0.316)ml/(min.g),均较烧伤组有明显升高(P<0.01);肝组织Bcl-2的表达明显增高;CSB组大鼠伤后肝组织病理改变较轻,主要表现为肝细胞浊肿,嗜酸性变,肝细胞脂肪变性。结论颈交感神经阻滞对重度烧伤大鼠肝脏具有保护作用,这种保护作用可能是通过调节下丘脑HPA轴和交感-肾上腺轴来进行的。
Objective To observe the protective effect of cervical sympathetic block (CSB) on the function and structure of liver in severely burned rats, and to explore its possible mechanism of protection. Methods The animals were randomly divided into control group, serious burn group and CSB treatment group according to the random number table to make severe burn model (TBSA20% Ⅲ degree). The CSB treatment group was treated with 0.1% ropivacaine on bilateral cervical sympathetic nerve Blocking. By detecting liver function, liver tissue antioxidant capacity, Bcl-2 expression and pathological changes of liver tissue to determine the protective effect of CSB on the liver. By detecting and monitoring blood pressure changes and detecting the amount of hepatic and hypothalamic blood perfusion to infer its possible mechanism. Results The levels of plasma albumin and alanine aminotransferase (ALT) in CSB group were not significantly increased at 1, 3, 5 and 7 days (48.98 ± 6.89) and (38.61 ± 4.35) and (24.05 ± (22.57 ± 4.10) mmol / L and plasma ALT concentrations were (48.15 ± 7.37), (58.21 ± 5.43), (62.07 ± 8.16) and (56.87 ± 5.88) IU / L, respectively, (3.16 ± 0.17), (2.88 ± 0.15), (2.71 ± 0.16) and (2.61 ± 0.58) U / mg in CSB group, respectively, which were significantly higher than those in burn group (P <0.01) 0.01). The blood pressure of the rats in the CSB group was stable after injury, with the time points of (90.58 ± 5.69), (82.69 ± 3.81), (70.61 ± 9.51), (82.05 ± 2.36) mmHg, compared with the burn group (P <0.01). The perfusion of organ in the CSB group was better than that in the burn group (0.302 ± 0.041, , (0.284 ± 0.024), (0.16 ± 0.023) and (0.256 ± 0.03) ml / (min.g), respectively. The hypothalamic blood flow volume was 1.013 ± 0.113, 0.721 ± 0.110, 0.944 ± 0.438, (0.765 ± 0.316) ml / (min.g), respectively, which were significantly higher than those in the burn group (P <0.01); the expression of Bcl-2 in liver tissue was significantly increased; Pathological changes in liver tissue lighter, mainly as hepatocellular cyst, eosinophilic, hepatocellular steatosis. Conclusion Cervical sympathetic nerve block has a protective effect on the liver of severely burned rats. The protective effect may be through regulating the hypothalamic HPA axis and sympathetic - adrenal axis.