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膀胱造瘘术对幼鼠膀胱功能的影响及其机制

Effects of cystostomy on bladders function in young rats and its potential mechanism

摘要:

目的:探讨膀胱造瘘对幼鼠膀胱功能的影响及病理生理机制。方法:80只SD雌性幼鼠采用随机数字表法分为膀胱造瘘组、假手术组(这2组包括术后第1、3、5天组),对照组(包括术后第1、3、5天对照组)和药物干预组,每组8只大鼠。膀胱造瘘组行膀胱造瘘,假手术组不放置造瘘管,药物干预组应用不同剂量山莨菪碱。对造瘘组幼鼠术后第1、3、5天亚组分别行清醒膀胱测压,收集排尿间隔(VI)、排尿量(VV)、残余尿量(PVR)、膀胱容量(BC)、最大膀胱压(Pves.max)、膀胱充盈末期压(Pves.thr)、膀胱顺应性(△C)。假手术组和对照组幼鼠自由排尿,收集VV、PVR、BC。尿动力学检测后取膀胱进行HE染色和炎症评分(HIS)。药物干预组应用不同剂量山莨菪碱干预,观察VI、VV、PVR,BC、Pves.max、Pves.thr变化情况。结果:膀胱造瘘术后,随时间延长,VV、VI、BC、△C呈上升趋势。与对照组VV[(1.408±0.033) mL]、BC [(1.411±0.032) mL]比较,造瘘组术后第1、3天的VV[(0.288±0.059) mL、(0.598±0.154) mL]和BC[(0.292±0.059) mL、(0.601±0.154) mL]均显著减少,差异均有统计学意义(均 P<0.05) 。与对照组比较,造瘘组术后第5天的VV、PVR、BC差异均无统计学意义(均 P>0.05) 。HE染色显示,造瘘组术后第1、3天和假手术组术后第1天HIS均>4分,造瘘组术后第5天和假手术组术后第3、5天HIS均<2分。造瘘组和假手术组术后第1、3、5天的HIS均呈下降趋势,相关性分析显示,幼鼠BC与HIS呈负相关( r=-0.880, P<0.001)。应用山莨菪碱0.2 mg/kg后,造瘘术后第3天幼鼠的VI、VV、BC较用药前显著增加[(643.500±65.889) s,(1.073±0.110) mL,(1.076±0.110) mL比(367.938±77.697) s,(0.612±0.129) mL,(0.617±0.129) mL,均 P<0.05],而PVR、Pves.max、Pves.thr较用药前无显著变化。 结论:幼鼠膀胱造瘘术后近期尿动力学的异常变化与损伤性急性膀胱炎症有关,术后第5天随着膀胱急性炎症的消退膀胱功能基本恢复正常,山莨菪碱在0.2 mg/kg剂量可有效缓解膀胱造瘘术后膀胱过度活动症状。

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abstracts:

Objective:To investigate the effects and mechanism of cystostomy on young rats′ bladders function.Methods:Eighty female SD rats were divided into cystostomy group, sham operation group (the two groups included day 1, 3, 5 after operation), control group(it included day 1, 3, 5 after operation) and medicine intervention group by using random number table, there were 8 rats in each group.Cystometry was conducted in cystostomy group (day 1, 3, and 5 postoperative subgroup), and voided interval (VI), voided volume (VV), postvoid residual urine (PVR), bladder capacity (BC), maximum bladder pressure (Pves.max), bladder threshold pressure (Pves.thr), and bladder compliance(△C) were recorded.The rats in sham operation and control groups voided freely in the condition of diuresis by intravenous infusion saline, and VV, PVR and BC were recorded.Bladders′ tissues were collected for HE staining and histopathological inflammation scores (HIS) after urodynamic investigations.In medicine intervention group, different doses of anisodamine were applied and the changes of VI, VV, PVR, BC, Pves.max and Pves.thr were observed.Results:The trend of VV, VI, BC and △C was upwards on days 1, 3, and 5 postcystostomy.Meanwhile, compared with control group [VV: (1.408±0.033) mL, BC: (1.411±0.032) mL], VV and BC on day 1 and 3 postcystostomy were less[VV: (0.288±0.059) mL, (0.598±0.154) mL; BC: (0.292±0.059) mL, (0.601±0.154) mL]. There were statistically significant differences ( P<0.05). However, VV, PVR and BC on day 5 postcystostomy were not different from that of control group(all P>0.05). HE staining demonstrated that the HIS of days 1 and 3 postcystostomy and day 1 post-sham operation were in severe inflammatory phase, with HIS >4 scores.Additionally, the inflammation on day 5 in cystostomy group and days 3-5 in sham operation group were mild (HIS<2 scores). The correlation test of BC and HIS was negative( r=-0.880, P<0.001). After the application of anisodamine on dose of 0.2 mg/kg, VI, VV and BC of the young rats on day 3 postcystostomy significantly increased, compared with those before intervention [(643.500±65.889) s, (1.073±0.110) mL, (1.076±0.110) mL vs.(367.938±77.697) s, (0.612±0.129) mL, (0.617±0.129) mL, all P<0.05], while PVR, Pves.max and Pves.thr did not significantly change compared with those before intervention. Conclusion:The recent abnormal changes of urodynamics postcystostomy were related to the traumatic acute bladder inflammation in the young rats.On day 5 after the surgery, the bladder function basically returned to normal with the regression of the acute bladder inflammation.Anisodamine at 0.2 mg/kg dose could effectively relieve the symptoms of overactive bladder postcystostomy.

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