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目的利用盲肠结扎穿孔伴严重腹腔感染造成的脓毒症模型,探讨胰岛素不同目标血糖对脓毒症肝、肺组织形态的影响。方法选取40只SD大鼠随机分为5组,通过盲肠结扎穿孔术(CLP)法制备大鼠脓毒症模型,按分组进行不同处理:假手术组(Sham组),CLP组,目标血糖控制A组、B组和C组,每组8只。CLP术后12h处死,通过组织形态观察,对肝、肺损伤不同病理积分进行评估。结果肝、肺组织病理总评分在CLP及血糖处理后明显高于Sham组(P<0.05)。在单项肝、肺的观察指标中,A组与Sham组比较,差异无统计学意义(P>0.05);3组血糖组肝、肺损伤程度随着血糖水平升高病变渐进加重,两两比较差异有统计学意义(P<0.05)。肺损伤主要表现为肺泡壁毛细血管充血、肺小叶及间质水肿、支气管炎,CLP组与血糖控制A、B、C3组比较,与A、B组差异有统计学意义(P<0.05),与C组差异无统计学意义(P>0.05)。肝损伤主要为肝细胞水样变性及脂肪变性,CLP组与血糖控制A、B、C 3组比较,差异有统计学意义(P<0.05),CLP组出现了明显碎片状坏死。结论脓毒症大鼠的肝、肺损伤程度随着血糖水平升高逐渐加重,控制血糖可使脓毒症模型鼠的肝、肺的损伤减低。
Objective To study the effect of different target blood glucose of insulin on the morphology of liver and lung in septic rats by using cecal ligation and perforation with sepsis caused by severe abdominal infection. Methods Forty Sprague-Dawley rats were randomly divided into five groups. The sepsis model was made by cecal ligation and puncture (CLP). The rats were randomly divided into sham operation group (sham group), CLP group, Group A, Group B and Group C, 8 rats in each group. CLPs were sacrificed at 12h after operation. The pathological scores of liver and lung injury were evaluated by histological observation. Results Liver and lung histopathological scores were significantly higher than those of Sham group after CLP and blood glucose treatment (P <0.05). There was no significant difference between Sham group and A group (P> 0.05). The levels of liver and lung injury in 3 groups were gradually increased with the increase of blood glucose level, The difference was statistically significant (P <0.05). Lung injury mainly manifested as alveolar wall capillary congestion, pulmonary lobular and interstitial edema, bronchitis, CLP group and blood glucose control A, B, C3 group, compared with A, B group was statistically significant (P <0.05) There was no significant difference with C group (P> 0.05). Liver damage was mainly caused by watery degeneration and steatosis of hepatocytes. There was significant difference between CLP group and A, B and C groups (P <0.05). Significant fragment necrosis occurred in CLP group. Conclusions The degree of liver and lung injury in sepsis rats gradually aggravates with the increase of blood glucose level. The control of blood glucose can reduce the liver and lung injury in sepsis model rats.