The Significance Of Mesenteric Lymphatic Drainage In Severe Acute Pancreatitis Complicated By Acute Lung Injury And Study Of The Intervention By Qing YiTang

Background: Severe acute pancreatitis (severe acute pancreatitis, SAP) complicated with acute lung injury (acute lunginjury, ALI) is the surgical acute abdomen, one of the difficult problems, and its pathogenesis is still not completely clear. Recent studies have found, SAP, the intestinal barrier dysfunction (intestine barrier functional disturbance, IBFD) can be caused by intestinal endotoxin (ET) and trypsin into the blood circulation, and then lead to inflammatory cytokines and inflammatory mediators in a chain reaction that led to the ALI major factor. Mesenteric lymphatic drainage and ET is trypsin into the blood circulation and the main way, which caused intestinal endotoxemia (IETM) and trypsin hyperlipidemia, ALI may be one of the initiating factors. Therefore, clearly superior mesenteric lymphatic drainage and severe acute pancreatitis complicated by acute lung injury (APALI) the relationship between the search for effective treatment of drug and measures APALI to explore the pathogenesis, and clinical treatment and reduce mortality APALI of great significance.Objective: To study the effect of mesenteric lymph of mesenteric lymph dry block, ET in serum and pancreatic amylase (AMY) concentration observed in lung tissue and pancreatic tissue pathology, arterial blood gas, the level of inflammatory cytokines and other related indicators changes, to explore the "SAP→IBFD→ET and trypsin by means of mesenteric lymph Hyperlipemia→IETM and trypsin→ALI" in the process, a clear APALI mesenteric lymphatic drainage of the significance in order to further reveal the pathogenesis of APALI . And to study Chinese medicine Qing Yi Tang in the treatment of APALI links, for clinical application of Chinese medicine Qing Yi Tang APALI effective treatment and provide a theoretical basis.Methods: 96 SD rats were randomly divided into sham operation group (SHAM group) 24, severe acute pancreatitis complicated by acute lung injury group (APALI group) 24, severe acute pancreatitis complicated by acute lung injury + mesenteric lymph stem resistance off group (LYMPH group) 24, severe acute pancreatitis complicated by acute lung injury + Chinese medicine Qing Yi Tang treated group (QYT group) 24, each further divided into 6h, 12h, 24h three subgroups, each subgroup 8 only. After retrograde cholangiopancreatography sodium deoxycholate into the prepara- tion of severe acute pancreatitis complicated by acute lung injury (APALI) model. LYMPH group be dry cephalic mesenteric lymph ligation processing; QYT group to preoperative oral administration of Chinese medicine Qing Yi Tang, dose 10mL/kg (24h to 12h when subgroups Qingyi Decoction be administered once, before the same dose).Sub-group of the corresponding time points in samples collected after the pathological examination and testing of the indicators. Rat lung tissue and pancreatic tissue specimens were observed pathological changes; the use of azo LAL chromogenic substrate for quantification of mesenteric lymph and serum levels of ET; The use of automatic biochemical analyzer measured in mesenteric lymph and serum levels of AMY; application of automatic determination of blood gas analysis machine indicators of abdo- minal aortic blood; the use of ELISA method for measuring serum levels of TNF-α; determined using enzyme chemical peroxidation of lung tissue myeloperoxidase enzyme (MPO) activity; lung tissue wet weight / dry weight ratio determination.Results: APALI group compared with the SHAM group, the rat mesenteric lymph and serum ET levels in mesenteric lymph and serum levels of AMY, serum levels of TNF-αsignificantly increased (p<0.01), a hypoxic blood disease, lung tissue wet weight / dry weight ratio increased, lung tissue MPO levels and other indicators of lung injury (p<0.01). LYMPH group through the ligation of mesenteric lymph dry, blocked the ET and trypsin way into the blood circulation, thereby reducing the serum levels of ET and AMY, improved indicators of lung injury (Group APALI comparison with p<0.05). Qing Yi Tang QYT group can be reduced in mesenteric lymph and serum levels of ET and AMY, in order to play a role in the protection of the lungs (compared with APALI group p<0.05).Conclusion: The present study confirmed the "SAP→IBFD→ET and trypsin by means of mesenteric lymph Hyperlipemia→IETM and trypsin→ALI" the existence of this process. ET mesenteric and intestinal lymphatic drainage into the blood circulation caused by trypsin and trypsin IETM hyperlipidemia, and the degree of lung injury was positively correlated, may be one of the pathogenesis of APALI. Chinese medicine Qing Yi Tang, through the protection of gut barrier function and reduce APALI when ET and pancreatic amylase way through the mesenteric lymph into the blood circulation, to reduce lung injury, which APALI a good therapeutic effect. APALI get a clear understanding of the pathogenesis, rational choice of drugs and therapeutic measures, the role of the different segments of the incidence, clinical treatment for APALI and possible to reduce the mortality.