| Objective:Based on the model of intestinal ischemia-reperfusion injury in rabbits,to investigate the effect and mechanism of Shenmai Injection on postoperative intestinal mucosal barrier through animal experiment and clinical research.Method:1.Animal experimentThe model of intestinal ischemia-reperfusion injury(I/R)was established in 60 old rabbits,which were randomly divided into three groups,15 for each group: Sham group,Model group,Low-dose Shenmai group and High-dose Shenmai group.Drugs were injected through ear edge vein: Low-dose Shenmai group: Shenmai injection was injected one day,30 mins before and after surgery with 1ml/kg;High-dose Shenmai group:Shenmai injection was injected one day,30 mins before and after surgery with 2ml / kg;Sham group and Model group: normal saline was injected at the same time point,as well as the volume.Serum D-lactate,malondialdehyde(MDA),diamine oxidase(DAO),tumor necrosis factor-?(TNF-?),bacterial migration rate,villus height,crypt depth and crypt depth of ileum,thickness of ileum and colon mucosa,the contents of claudin-1,occludin and ZO-1 in ileum tissue were detected at the time of pro-day 1,post-day 1,3 and 7.2.Clinical research80 patients in our hospital with total knee arthroplasty,total hip arthroplasty and artificial femoral head replacement were enrolled.The patients were divided into Observation group and Control group with random number table,40 cases in each group.In the Observation group,Shenmai injection was injected from the day 1 before surgery,30 mins before surgery and the day 3 after surgery;in the Control group,normal saline of equal volume was injected at the same time.The levels of DAO,LPS,MDA and TNF-? in serum were measured day 1 before,and day 1,3 and 5 days after the surgery.The abdominal pain and distention,infection related complications,length of stay,cost of in hospital and post-surgical exhaust time were analyzed.Results:1.Animal experiment(1)On the 7th day after surgery,the intestinal mucosal thickness,villus height,crypt depth,villus surface area in Model group,Low-dose Shenmai group and High-dose Shenmai group were significantly lower than those in the Sham group(P < 0.05);the intestinal mucosal thickness,villus height,crypt depth,villus surface area in Low-dose Shenmai group and High-dose Shenmai group were significantly higher than those in model group(P < 0.05);also those were much higher in High-dose Shenmai group than in Low-dose Shenmai group(P < 0.05)(2)There was no significant difference in the levels of serum D-lactate,DAO,TNF-? and MDA between the groups before surgery(P > 0.05).On the 1st day,the 3rd day and the 7th day after surgery,the levels of serum D-lactate,DAO,TNF-? and MDA in Model group,Low-dose Shenmai group and High-dose Shenmai group were significantly higher than that in Sham group(P < 0.05);the levels of serum D-lactate,DAO,TNF-? and MDA in Low-dose Shenmai group and High-dose Shenmai group were significantly lower than that in Model group(P < 0.05);the levels of serum D-lactate in High-dose Shenmai group was significantly lower than that in Low-dose Shenmai group(P < 0.05).(3)On the 7th day after surgery,the positive rate of bacterial translocation in the Model group and Low-dose Shenmai group was significantly higher than that in Sham group(P < 0.05);the positive rate of bacterial translocation in Low-dose Shenmai group and High-dose Shenmai group was significantly lower than that in Model group(P < 0.05).(4)On the 7th day after surgery,the protein of ileum claudin-1,occludin and ZO-1 in Model group,Low-dose Shenmai group and High-dose Shenmai group were significantly lower than those in Sham group(P < 0.05);the protein of ileum claudin-1,occludin and ZO-1 in Low-dose Shenmai group and High-dose Shenmai group were significantly higher than those in Model group(P < 0.05);and the protein of ileum claudin-1 and ZO-1 in High-dose Shenmai group were significantly higher than those in Low-dose Shenmai group(P < 0.05).2.Clinical research(1)There was no significant difference in the levels of serum DAO,LPS,D-lactate,MDA and TNF-? between two groups before surgery(P> 0.05).The levels of DAO,LPS,D-lactate,MDA and TNF-? in the Observation group were significantly lower than those in the Control group on the 1st,3rd and 5th day after surgery(P <0.05).(2)The abdominal pain and distention,postoperative exhaust time and infection related complications in the Observation group were significantly lower than those in the Control group(P <0.05).The hospitalization time and hospitalization cost had no significant differences(P> 0.05).Conclusion:1.Shenmai injection has a significant protective effect on intestinal mucosa after I/R in rabbits.The mechanism may be related to the decrease of intestinal permeability,the inhibition of lipid peroxidation of epithelial cells,the reduction of expression of TNF-?,and the enhancement of tight connection of intestinal cells,so as to significantly reduce the degree of intestinal tissue damage,and ultimately achieve the protective effect on intestinal mucosa.2.The clinical study confirmed that Shenmai injection has obvious protective effect on the intestinal mucosa of the elderly patients undergoing operation.Its mechanism may be related to the inhibition of lipid peroxidation of the epithelial cells of the mucosa,the reduction of the expression of inflammatory factor TNF-?,and the reduction of the permeability of the intestinal mucosa. |
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