發(fā)布時(shí)間：2018-01-16 02:21

  本文關(guān)鍵詞：血清C5a在尿源性膿毒血癥中的變化及其阻斷對感染性休克的影響　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腔內(nèi)碎石術(shù) 尿源性膿毒血癥 感染性休克 C5a PMX-53 動物模型

【摘要】：目的:尿源性膿毒血癥是腔內(nèi)碎石術(shù)后的嚴(yán)重并發(fā)癥之一,早期診斷和治療對改善預(yù)后非常重要。我們通過建立腎盂內(nèi)高壓伴感染的動物模型,研究尿源性膿毒血癥的發(fā)展過程中血清補(bǔ)體成分C5a的變化,分析C5a對感染性休克的早期預(yù)警價(jià)值,探究早期用PMX-53阻斷C5a與其受體的結(jié)合能否改善感染性休克的預(yù)后。方法:首先,將40只雌性新西蘭兔隨機(jī)分為A1、A2、A3及A4四組,向各組兔的腎盂內(nèi)注入等量生理鹽水或不同濃度梯度的標(biāo)準(zhǔn)大腸桿菌溶液,分別監(jiān)測術(shù)前、術(shù)后的平均動脈壓和血清C5a濃度,以探索腎盂內(nèi)高壓伴感染致急性感染性休克的標(biāo)準(zhǔn)模型濃度。其后,將另40只新西蘭兔隨機(jī)分為B、C、D1及D2四組。對B組,腎盂內(nèi)注入生理鹽水,對C、D1、D2組,腎盂內(nèi)注入致感染性休克濃度的標(biāo)準(zhǔn)大腸桿菌溶液;術(shù)后,對B、C組,在術(shù)后1小時(shí)靜脈注射生理鹽水,對D1、D2組注射等量但不同濃度的PMX-5生理鹽水溶液,監(jiān)測實(shí)驗(yàn)兔的平均動脈壓、血清C5a的濃度和存活時(shí)間。結(jié)果:腎盂內(nèi)注射生理鹽水組的實(shí)驗(yàn)兔術(shù)后8小時(shí)內(nèi)平均動脈壓較基礎(chǔ)動脈壓無明顯下降。隨著注入細(xì)菌濃度的升高和術(shù)后時(shí)間的延長,各注射大腸桿菌組的實(shí)驗(yàn)兔術(shù)后平均動脈壓呈現(xiàn)下降趨勢,其中A4組在術(shù)后6小時(shí)的血壓較基礎(chǔ)血壓的下降有統(tǒng)計(jì)學(xué)顯著性。因此選擇A4組所用大腸桿菌濃度作為新西蘭兔尿源性休克的標(biāo)準(zhǔn)模型濃度。生理鹽水組在術(shù)后8小時(shí)內(nèi)血清C5a濃度較術(shù)前相比無明顯差異,各注射大腸桿菌組在術(shù)后8小時(shí)內(nèi)血清C5a濃度呈逐漸升高趨勢,且隨著大腸桿菌溶液濃度的升高,血清C5a升高的幅度增大。其中,A3組與A4組,與術(shù)前相比術(shù)后6小時(shí)血清C5a、8小時(shí)血清C5a均顯著性升高。B組術(shù)后血壓無明顯下降(除外麻醉影響),術(shù)后24h存活;血清C5a濃度較術(shù)前相比無明顯差異。C組在術(shù)后8.5±0.7小時(shí)出現(xiàn)休克,11.3±1.1小時(shí)死亡;術(shù)后8小時(shí)內(nèi)血清C5a濃度呈逐漸升高趨勢。D1、D2組在術(shù)后出現(xiàn)休克及死亡時(shí)間均晚于C組;術(shù)后C5a升高幅度小于C組。結(jié)論:該動物模型研究表明血清C5a升高程度與感染程度密切相關(guān),監(jiān)測術(shù)后血清C5a的濃度有助于判斷術(shù)后膿毒血癥的發(fā)生及嚴(yán)重程度。早期用PMX-53阻斷C5a與其受體C5aR的結(jié)合可以延緩術(shù)后的感染進(jìn)程,從而推遲感染性休克的發(fā)生。通過優(yōu)化PMX-53的用量及給藥時(shí)間,有可能進(jìn)一步控制感染的進(jìn)展,甚至可能避免尿源性感染性休克的發(fā)生,但這需要進(jìn)一步的實(shí)驗(yàn)驗(yàn)證。
[Abstract]:Objective: urine derived sepsis is one of serious complications after endoscopic lithotripsy, early diagnosis and treatment is very important for improving the prognosis. We through the establishment of animal model of hypertension and renal pelvic infection, changes of serum complement C5a development process research of urosepsis in the analysis of C5a for the early warning value of septic shock the inquiry, early PMX-53 blocking the binding of C5a to its receptors can improve the prognosis of septic shock. Methods: first, 40 female New Zealand rabbits were randomly divided into A1, A2, A3 and A4 four groups, injected into the standard Escherichia coli solution saline or different concentration gradient to rabbit renal pelvis, respectively. Monitoring the preoperative, postoperative mean arterial pressure and serum concentration of C5a, to explore the renal pelvis with high concentration of standard model of infection caused by acute septic shock. Later, the other 40 New Zealand rabbits were randomly divided into B, C D1, and D2 four groups. In group B, intrapelvic injection of saline, C, D1, D2 group, the renal pelvis into standard E. coli solution induced septic shock concentration; after the operation, the B, C group, 1 hours after intravenous injection of saline, D1 group, D2 injection but with different PMX-5 saline solution concentration, mean arterial pressure monitoring in rabbits, the concentration of serum C5a and survival time. Results: the intrapelvic injection of saline group rabbits after 8 hours compared with the mean arterial pressure of arterial pressure decreased significantly. With increasing injection of bacteria concentration and time after operation and the injection of Escherichia coli group in rabbits after operation the mean arterial pressure decreased, the A4 group 6 hours after the blood pressure is the basis of blood pressure was statistically significant. So the choice of group A4 with the concentration of E. coli as the concentration of New Zealand rabbits urogenic shock in the standard model. The saline group in serum within 8 hours postoperatively compared with the preoperative C5a concentration showed no significant difference, the injection of Escherichia coli group. The serum C5a concentration in 8 hours after operation gradually increased, and increased with the increasing concentration of Escherichia coli solution, elevated serum C5a increased. Among them, A3 group and A4 group, compared with 6 hours after surgery and preoperative serum C5a, serum C5a 8 hours were significantly increased after operation in.B group decreased significantly (except blood pressure without anesthesia), survival after 24h; the concentration of serum C5a compared with preoperative.C group showed no significant difference in postoperative 8.5 - 0.7 hours to shock, 11.3 - 1.1 hours of death; the serum C5a concentration increased with.D1 within 8 hours after operation, group D2 shock and death time were later than in the C group after surgery; postoperative C5a was significantly less than that of C group. Conclusion: the study showed that the animal model is closely related to the increased serum C5a level and the degree of infection, monitoring of postoperative serum C The concentration of 5A is helpful in judging the postoperative sepsis incidence and severity. Early PMX-53 blocking C5a binding to its receptor C5aR can delay the progress of infection after surgery, which delayed septic shock occurs. Through the optimization of PMX-53 dosage and administration time, may further control the progression of the infection, and may even avoid urine and septic shock occurred, but this needs further experimental verification.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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本文編號：1431126