摘要
目的探讨模拟高原高寒条件对兔模型严重腹腔感染的影响。方法将60只新西兰大白兔随机分为平原组(海拔高度100 m,温度5℃)、亚高原组(海拔高度1000 m,温度–5℃)与高原组(海拔高度5000 m,温度–25℃),每组20只。各组于相应条件动物饲养舱内饲养14 d,然后采用盲肠结扎穿孔法(CLP)建立严重腹腔感染模型。术前测定各项基础数据,术前及术后24、72 h抽取耳缘静脉血,采用ELISA法测定C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)、白蛋白(ALB)、前白蛋白(PAB)水平,采用血常规试剂进行白细胞计数(WBC)。术后72 h处死,抽取腹腔积液送腹水培养,采集肝脏、肾脏、小肠组织行HE染色观察病理变化。采用Pearson相关法分析各项感染指标与高原高寒因素的相关性。结果术后72 h,平原组、亚高原组和高原组CLP模型兔生存率依次为65.0%(13/20)、35.0%(7/20)、10.0%(2/20)。随着海拔高度增加、温度降低,CLP模型兔的生存率逐渐降低(P<0.01)。各组CLP模型兔均在术后6 h开始出现少动、蜷缩、精神倦怠、呼吸急促且呼吸音粗、腹泻、眼角渗出物等症状。平原组术后肛温持续升高后缓慢降低,最高为39.2℃,最低为36.5℃;亚高原组术后肛温急剧升高后逐渐降低,最高为40.6℃,最低为34.9℃;高原组术后肛温急剧升高后迅速降低,最高为41.2℃,最低为34.0℃。术后24、72 h,高原组与亚高原组CLP模型兔静脉血中PCT、TNF-α水平高于平原组,且高原组高于亚高原组(P<0.05);术后72 h,高原组与亚高原组CLP模型兔静脉血中ALB、PAB水平低于平原组,且高原组低于亚高原组(P<0.05)。Pearson相关分析结果显示,PCT、TNF-α与高原高寒因素呈正相关(r=0.288,r=0.368,P<0.05),WBC、CRP与高原高寒因素无相关性(r=0.462,r=0.397,P>0.05)。腹水培养结果显示,平原组、亚高原组和高原组分别分离出51、69、107株病原,其中革兰阴性菌依次占52.94%(27/51)、49.27%(34/69)、42.06%(45/107),革兰阳性菌依次占29.41%(15/51)、34.78%(24/69)、43.93%(47/107)。结论高原高寒是CLP模型兔感染程度和死亡的重要影响因素,可加重腹腔感染,损害重要脏器功能,影响机体的营养吸收与代谢,且该条件下致病菌群与平原地区存在差异,可能影响腹腔感染性疾病的进程及治疗,值得深入研究。
Objective To investigate the effect of simulated high altitude and cold conditions on the model of severe abdominal infection in rabbits.Methods 60 New Zealand rabbits were randomly divided into plain group(altitude 100 m,temperature 5℃,n=20),sub-plateau group(altitude 1000 m,temperature–5℃,n=20)and plateau group(altitude 5000 m,temperature–25℃,n=20).Each group was kept in the corresponding animal feeding cabin for 14 days,then induced severe abdominal model by cecal ligation and puncture(CLP).The basic data were measured before operation,and the peripheral vein blood was extracted 24 and 72 hours after operation.The levels of C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor-α(TNF-α),albumin(ALB),prealbumin(PAB)were measured by ELISA,and the white blood cell count(WBC)was performed.The rabbits were killed 72 hours after operation,the ascites were collected from the abdominal fluid,and collected liver,kidney and small intestine,and the pathological changes were observed by HE staining.Pearson correlation was used to analyze the correlation between the infection indexes and the high cold factors at high altitude.Results Seventy-two hours after operation,the survival rate of CLP model rabbits in plain group,sub-plateau group and plateau group was 65.0%(13/20),35.0%(7/20),10.0%(2/20),respectively.With the increase of altitude and the decrease of temperature,the survival rate of CLP model rabbits decreased gradually(P<0.01).All CLP rabbits began to show signs of less movement,curling,mental burnout,shortness of breath,coarse breath tone,diarrhea and eye corner exudates.In the plain group,the anal temperature increased continuously and then decreased slowly,with the highest value of 39.2℃and the lowest value of 36.5℃;in the sub-plateau group,the anal temperature increased sharply and then decreased gradually,with the highest value of 40.6℃and the lowest value of 34.9℃;in the plateau group,the anal temperature decreased rapidly,with the highest value of 41.2℃and the lowest value of 34.0℃.At 24 and 72 hours after operation,the levels of PCT and TNF-αin venous blood of CLP model rabbits in plateau group and sub-plateau group were higher than those in plain group,and those in plateau group were higher than those in sub-plateau group(P<0.05);at 72 hours after operation,the levels of ALB and PAB in venous blood of CLP model rabbits in plateau group and sub-plateau group were lower than those in plain group,and those in plateau group were lower than those in sub-plateau group(P<0.05).Pearson correlation analysis showed that PCT,TNF-αwere positively correlated with high altitude cold factors(r=0.288,r=0.368,P<0.05),WBC and CRP had no significant correlation with them(r=0.462,r=0.397,P>0.05).The results of ascite culture showed that 51,69 and 107 pathogens were isolated from plain group,sub-plateau group and plateau group respectively,among which gram-negative bacteria accounted for 52.94%(27/51),49.27%(34/69),42.06%(45/107),and gram-positive bacteria accounted for 29.41%(15/51),34.78%(24/69),43.93%(47/107).Conclusion The high cold condition at high altitude is an important factor in the infection degree and death of CLP model rabbits.It can aggravate the infection of abdominal cavity and damage the important organ function,affect the nutrition absorption and metabolism of the body.The difference between the pathogenic bacteria and the plain area under this condition may affect the process and treatment of abdominal infection diseases,which is worth further study.
作者
段光辉
瞿洪洋
高笑欣
尚力凝
杜成周
陈鹏
李洪涛
Duan Guang-Hui;Qu Hong-Yang;Gao Xiao-Xin;Shang Li-Ning;Du Cheng-Zhou;Chen Peng;Li Hong-Tao(Department of General Surgery,the 940 Hospital of the Joint Service Support Force of Chinese PLA,Lanzhou 730050,China;Graduate School of Ningxia Medical University,Yinchuan 750004,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2021年第5期432-439,共8页
Medical Journal of Chinese People's Liberation Army
基金
国家科技部、财政部惠民计划项目(2012GS620101)
甘肃省科技重大专项基金(2011GS04390)
甘肃省自然科学基金(1506RJZA309)
中国博士后科学基金(2015M572710)。
关键词
高原高寒
腹腔感染
脓毒症
盲肠结扎穿孔动物模型
high altitude cold
abdominal infection
sepsis
cecal ligation and puncture animal model
