| Adhesive intestinal obstruction(AIO)is a kind of clinical disease caused by adhesive intesinal which leads to transmission disorder of intestinal content.It is one of most clinical frequent acute abdomen disease.It may cause many kinds of severe complication for threating to life such as multiple system organ failure(MSOF).It is a common and intractable problem.The incidence of postoperative intestinal obstruction in abdominal cavity is up to 80-90%,and abut 30%of them is adhesive.It means a lot of pain and cost that patient should suffer from.Although many medicines can play some roles,there is still one recognized method is available for prevention of adhesion in abdominal cavity.It is one of the most important tasks in the medical field to actively search for how to prevent and cure AIO.The following two aspects are concerned in this dissertation to discuss AIO systematically in the field of acupuncture and moxibusfion of traditional Chinese medicine.1.Literature researchOn reviewing the knowledge of AIO,animal model of AIO in western medicine.The authors pointed out that there was closely related between AIO and mucosal barrier.There were some kinds of mucosal barriers,such as physico-barrier,immunologic barrier, microeconomy barrier and chemical barrier.Physico-barrier,immunologic barrier played more important role in AIO.It was thought that degenerative nervous transmitter, hyperactive polyol metabolism,increased free radical and decreased cerebral blood circulation generated diabetic cognitive dysfunction.Disruption of gastroin-testinal epithelial barrier integrity may induce increasing of permeability of gastrointestinal wall,bacterial and endotoxin translocation,releasing inflammatory mediators,and lead to lethal sepsis and distant organ injury,finally result in multiple system organ failure.The original sign of impairment of mucosal is increasing of permeability.Before the marked change of morphology of mucosal,increasing of permeability of intestinal tract has happened.So increasing of permeability of mucosal can reflect injury of intestinal barrier earlier.Increasing of permeability of mucosal may provide a chance for absorption of toxin in enteric cavity,which is the pathological foundation of bacterial translocation.Barrier of preventing bacterial translocation is comprised of follow:①The mechanical barrier is comprised of continual epithelial of mucosal;②Cellular and humoral immunity provided by lymphoid tissue of intestinal tract;③Normal and massive commensal intestinal bacterial clusters,preventing the over proliferating and permanent planting in mucosal of pathogenic micmorganism.One or several of these were injuried, that will induce bacterial translocation.Many scholars have paid attention to the intestinal barrier function.As far as its treatment was concerned,at present,it still stayed at operation and infusing into abdominal cavity with some special medicine such as sodium hyaluronate, urokinase and intralipid et al.On reviewing the etiology and pathogenesis,treatment selection on syndrome differentiation of AIO in TCM,the author pointed out that the history of the cognition of physiology and pathology for the coeliac disease in TCM is very long.Not a few literatures are relative to AIO,while none of them is specialized in AIO.The symptoms are included in the following chapters,such as "bellyache","accumulation"," intense carotid and radial pulsation",etc.Acu-bustion has many kinds of therapeutic methods including acupunture, moxibustion,tuina,decoction edema,etc.It has desirable effect on AIO.In addition,my director has got a great experience on research of AIO.On reviewing the cognition of AIO in both Traditional Chinese Medicine and modern medical science,the author pointed out that there is stable and forceful theoretic foundation and significant clinical meaning to probing into the protective effect of acupuncture in points for the treatment of AIO.2.Experimental researchPurpose:To probe the protective effect of acupuncture for the treatment of AIO from the angle of animal experiment.Methods:75 SD rats were randomly divided into groups:normal group, sham-operation group,model group,Dachengqi decoction enema group;acupuncture group. Acupuncture group was treated by electro-Acupuncture 30 min every day.Acupoints chosen in acupuncture group were as follows:Zusanli(ST36),Tianshu(ST25),Shangjuxu (ST37).Enema group was given enema with Dachengqi decoction 5ml/kg once everyday while sham-operation group and model group with physiological saline at same dose.All of the experimental animals were averagely put to death on the 4th,14th,28th day after operation,and collected serum and samples,measured and observed the following indexes:(1)The chiu score and W/D ratio of intestinal mucosa injury,The Phyllips score of adhesive intestinum.(2)The pathomorphological change of intestinal mucosa in adhesive intestinal obstruction injury rat models with light-microscope.(3)The ultrastructure change of Intestinal Mucosa in adhesive intestinal obstruction injury rat models with electon-microscope,including the amounts of bacterium cytoryctes cell and rough endoplasmic reticulum rough endoplasmic reticulum cav.(4)The activity of diamine oxidase(DAO)of intestinal mucosa.(5)The content of D-lactate in plasma.(6)The content of secreted immunoglobulin A(sIgA)in intestinal mucosa.(7)The changes of CD4~+ and CD8~+ T-Lymphocytes in intestinal mucosa.(8)The changes of the intestinal bacteria translocation rate.Results:(1)Edema of intestine in model group was serious.The W/D ratio in three operation group was significantly higher(p＜0.05)than that in the sham-operation group at all time points,but it was obviously reduced by the acupuncture treament at 14,28 days after operation.Adhesive intestinum in model group was compacted and twisted lumping,proximate intestinal of some stage became distention,other distal end intestinal was coarctation and thin than normal group.The Phyllips score and chiu score of adhesive intestinum was significantly higher(P＜0.01)than that in the sham-operation group and normal group at all time points,but it was obviously reduced by acupuncture or enema treament at 14,28 days after operation(P＜0.05).(2)The intestinal mucosa injury of model group in light-microscope was worse than other groups.There was great amount of degen-akaryocyte and amotio epithelium mucosae endothelial cell,villi was getting confused,atrophy and shorter.Intestinal villi edema, capillary congestion,polymophonuclear infiltration in enteric cavity was noted in the model group after intestinal operation,pathomorphological change of the enema group and acupuncture group in light-microscope was better than model group.(3)The amounts of bacterium cytoryctes cell and rough endoplasmic reticulum rough endoplasmic reticulum car in model group after 4 days were highest.And then it was obviously reduced by acupuncture than that in enema group after 14,28days (P＜0.05).There was no significantly(P＞0.05)higher between normal groups and sham-operation.The amounts of microvilli,mitochondria and rough surface endoplasmic reticulum(RSER)were all decreased,infiltration of inflammatory cells were increased under the electromicroscope.Acupuncture can improve the ultrastructure injury of the obstructive intestinal tissues,promote the recovery of both the function and morphology of the mitochondria and RSER.(4)The DAO of intestinal mucosa in model group was significantly reduced than that in the sham-operation group at all time points,and the DAO in plasma was higher inversely (P＜0.01).But the DAO of intestinal mucosal in acupunture group was obviously increased by the acupuncture treament at 14,28 days after operation,DAO in plasma was decreased at all time points.There was no significantly higher between normal group and shamoperation group.(P＞0.05)(5)The content of D- lactate in model group was significantly higher than that in the sham-operation group at all time points(P＜0.01),especially after 14days.There was same tendency both in enema group and acupuncture group.But The content of D- lactate was obviously reduced by the acupuncture treament at 14,28 days after operation,there was no significantly higher between enema group and acupuncture group(P＞0.05),and the same between normal group and sham-operation group(P＞0.05).(6)The sIgA contents was obviously decreased at all time points compared with that in the sham operation group(P＜0.01).The level of sIgA in the acupuncture group was higher than that in the enema group at 14,28 days after acupuncture.(P＜0.05).There was no significantly higher between normal group and sham-operation group(P＞0.05).(7)Compared with the sham-operation group,in the model group,numbers of CD4 ~+ and ratio of CD4~+/CD8~+ were reduced signifcantly(P＜0.01).After acupuncture treatment, CD4~+ T-lymphocytes and ratio of CD4~+/CD8~+ were increased significantly showed in comparison between the model group(P＜0.05).There was no significantly higher between normal group and sham-operation group(P＞0.05).(8)The rate of intestinal bacteria translocated to live,spleen and mesenteric nodes in model group was significantly higher than that in the sham-operation group at all time points(P＜0.01),and it reach highest at 14days after operation.The intestinal bacteria rate was obviously reduced by the acupuncture treament than that in model group at 28 days after operation(P＜0.01),there was no significantly higher between enema group and acupuncture group(P＞0.05)Conclusions:(1)Acupuncture can relieve the edema of the obstructive intestinal tissues,The chiu score and W/D ratio of intestinal mucosa injury,the Phyllips score of adhesive intestinum were all decreased.Acupuncture can relieve intestinal adhensive.(2)Acupuncture can improve the ultrastructure injury of the obstructive intestinal tissues,promote the recovery of both the function and morphology of the mitochondria and rough surface endoplasmic reticulum(RSER).The amounts of bacterium cytoryctes cell and rough endoplasmic reticulum rough endoplasmic reticulum cav were all decreased. Acupuncture can enhance the defence-barrier function of intestinal mucosa.(3)Acupuncture can depress its permeability and protect its integrity efficiently, enhance the barrier function of intestinal mucosa,incresase the activity of DAO both in plasma and intestinal mucosa,reduce the content of D-lactate in plasma.(4)Acupuncture may promote or elevate the synthesis and secretion of sIgA,increase CD4~+ T-lymphocytes and ratio of CD4~+/CD8~+,enhance the intestinal local immunity, reduce the intestinal bacteria translocation.It can protect the intestinal mucosa and reinforce its immunologic barrier function.(5)Acupuncture can enhance both the physico-barrier and immunologic barrier function of intestinal mucosa,protest the the intestinal mucosa from adhesive intestinal obstruction injury... |
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