摘要
目的探讨不同渗透压液体洗胃对兔胃黏膜和血浆渗透压的影响。方法将32只日本长耳大白兔随机分为正常对照组（NC组）、清水组（CW组）、0．45％氯化钠溶液组（HS组）、0．9％氯化钠溶液组（NS组），每组8只。根据重力洗胃法原理进行洗胃。洗胃参数：洗胃液温度37-38℃，进出压力10-15kPa，进液量25mL/kg，周期30s，持续时间40-50min。CW组、HS组、NS组分别用清水、0．45％氯化钠溶液和0．9％氯化钠溶液进行洗胃；NC组仅置胃管不洗胃。在置胃管前及洗胃后，采动脉血；然后用气栓法处死兔，取出胃，在肉眼和光镜下评价胃黏膜损伤程度。结果洗胃前各组兔血浆电解质、渗透压比较差异无统计学意义。洗胃后CW组和HS组血钠浓度[（128．63±7．13）mmol/L和（131．88±4．55）mmol/L]显著下降，与NC组（136．38±3．58）mmol/L和NS组（140．13±0．83）mmol/L比较，差异有统计学意义（P＜0．05）；CW组、HS组和NS组血钾浓度[（2．13±0．35）mmol/L、（2．19±0．36）mmol/L和（2．11±0．24）mmol/L]显著下降，低于NC组（2．73±0．41）mmol/L，差异有统计学意义（P＜0．05）；CW组、HS组和NS组血钙浓度[（1．23±0．12）mmol/L、（1．34±0．13）mmol/L和（1．38±0．10）mmol/L]显著下降，CW组显著低于NS组（P＜0．05）。CW组和HS组洗胃前后血浆渗透压显著下降[（295．59±11．75）mmol/Lvs（269．32±13．94）mmol/L和（290．99±5．52）mmol/Lvs（278．96±8．66）mmol/L）]，也显著低于洗胃后NC组（290．74±6．11）mmol/L和NS组（292．56±2．59）mmol/L，差异有统计学意义（P＜0．05）。NS组、HS组和CW组胃黏膜损伤指数（28．88±14．63、42．63±21.03和48．25±17．27）较NC组（0．38±0．74）显著升高，CW组显著高于NS组（均P＜0．05）；NS组、HS组和CW组胃黏膜上皮损伤评分（2．88±2.03、3．50±2．14和5．50±2．20）较NC组（0.25±0．46）显著升高，CW组高于NS组（均P＜0.05）。结论用清水和0．45％氯化钠溶液洗胃可造成兔胃黏膜损伤，引起血钠、血钾、血钙和血浆渗透压下降；0．9％氯化钠溶液洗胃造成的胃黏膜损伤较轻，对血钠和血浆渗透压无显著影响，并可减缓血钙浓度的下降程度。不同渗透压液体洗胃导致兔不同程度的水电解质紊乱与胃黏膜损伤程度不同有关。
Objective To study the effect of gastrolavage with different osmotic pressure solution on gastric mucosa in rabbits.Methods Thirty-two rabbits were randomly divided into four equal groups：normal control （NC） group, clear water （CW） group, 0.45% sodium chloride solution （ HS） group, 0.9%sodium chloride solution （ NS） group.After the rabbits were anesthetized, we give them gastric lavage with homemade improvised gastric lavage apparatus.The blood samples of each group were collected at pre -gastrolavage and post -gastrolavage, plasma electrolytes were measured and plasma osmotic pressure was calculated.At the end of the experiment, the rabbits were sacrificed, then stomachs were removed.The injury level of the gastric mucosa was observed by the naked eyes and light. Results Before gastrolavage, plasma electrolytes and osmotic pressure did not show significant difference among the groups （P〉0.05）.After gastrolavage, plasma sodium concentration in CW group and HS group [（128.63 ±7.13）mmol/L, （131.88 ±4.55）mmol/L] significantly decreased and were lower than that in NC group and NS group [（136.38 ±3.58）mmol/L],（140.13 ±0.83）mmol/L,P〈0.05].Plasma potassium concentration in CW group, HS group and NS group [（2.13 ±0.35）mmol/L,（2.19 ±0.36）mmol/L,（2.11 ±0.24）mmol/L]significantly decreased and were lower than that in NC group[（2.73 ±0.41）mmol/L,P〈0.05].Plasma calcium concentration in CW group, HS group and NS group [（1.23 ±0.12）mmol/L,（1.34 ±0.13）mmol/L,（1.38 ±0.10）mmol/L] significantly decreased compared with that of pre-gastrolavage [（1.38 ±0.12）mmol/L,（1.42 ±0.08）mmol/L, （1.43 ±0.08）mmol/L,P〈0.05].Plasma calcium concentration in CW group was lower than that in NS group （P〈0.05）.Plasma osmotic pressure in CW group and HS group [（269.32 ±13.94）mmol/L,（278.96 ±8.66） mmol/L] significantly decreased and were lower than that in NC group and NS group [（290.74 ±6.11）mmol/L,（292.56 ±2.59）mmol/L,P〈0.05].The gastric mucosa epidermal damage score （EDS） and damage index （DI） in NS group, HS group and CW group （2.88 ±2.03, 3.50 ±2.14, 5.50 ±2.20, 28.88 ±14.63, 42.63 ±21.03, 48.25 ±17.27） were significantly higher than that in NC group （0.25 ±0.46, 0.38 ±0.74） （P〈0.05）.The gastric mucosa EDS in NS group （2.88 ±2.03） were significantly lower than that in HS group and CW group （3.50 ±2.14, 5.50 ± 2.20） （P〈0.05）.The gastric mucosa DI in CW group （48.25 ±17.27） were significantly higher than that in NS group （ 28.88 ±14.63 ） （ P 〈0.05 ） .Conclusion Gastrolavage with clear water and 0.45%sodium chloride solution may cause gastric mucosa damage and the decrease of the plasma electrolytes and osmotic pressure.Gastrolavage with 0.9% sodium chloride solution has lighter damage on gastric mucosa and no obvious effect on plasma osmotic pressure.Different osmotic solution gastric lavage leads to different degree of water electrolyte disorder associated with different degree of gastric mucosa damage.
出处
《中国急救医学》
CAS
CSCD
北大核心
2014年第11期1039-1043,共5页
Chinese Journal of Critical Care Medicine
关键词
兔
洗胃液
血浆电解质
血浆渗透压
黏膜损伤
Rabbit
Solution of gastric lavage
Plasma electrolytes
Plasma osmotic pressure
Gastric mucosa damage
