Effect Of Qihuang Decoction On Gastrointestinal Motility After Gastrectomy And Its Molecular Mechanism Based On ENS Framework

Objective1 Clinical researchThe patients with gastrotomy were given Jianpi Tongli herbs Qihuang decoction in the early small intestine.To investigate the effect of Qihuang decoction on the recovery of gastrointestinal motility after gastrectomy by observing the time of gastrointestinal motility recovery.Through the observation of gastrointestinal complications(malignant vomiting,abdominal pain and bloating)in the two groups,to explore whether Qihuang decoction can reduce postoperative discomfort and complications;By observing changes in gastrointestinal hormones(MOT,GAS,SS,VIP),To explore whether Qihuang decoction can regulate postoperative gastrointestinal hormones,and further explore the possible mechanism of Qihuang decoction to promote gastrointestinal motor function recovery.2 Experimental studyA rat model of gastrectomy trauma was established,and Qihuang decoction was administered to investigate whether it can promote the recovery of gastrointestinal movement by observing the small intestine advancing rate.The morphological structure,distribution and number of ACh?SP?VIP?NO positive neurons in the ENS network were detected by immunofluorescence labeled laser scanning confocal microscopy and fluorescence microscopy,and whether it is helpful for the reconstruction and recovery of the ENS network was discussed;through detection of ENS network intestinal neurotransmitters(AChE,SP,VIP,NOS)and its receptors(M3R,VIP2R,NK1R)mRNA expression levels and protein translation,explore:whether the restoration of the ENS network structure marks the restoration of its function(secretion of normal neurotransmitters),further explore the effect of Qihuang decoction on gastrointestinal motility Material basis and molecular mechanism of functional recovery.Methods1 Clinical researchEighty patients undergoing gastrectomy were divided into the study group(40 patients)and the control group(40 patients)according to different treatment methods.The control group was given intestinal nutrition emulsion TPF nutrition tube instillation,and the research group was given the Herbs Qihuang decoction nutrition tube infusion on the 1st to 7th day after operation.Observe the two groups respectively:Intestinal motility recovery time:(bowel sounds recovery time,anal exhaust defecation time,resumed feeding time,contrast agent reaching ascending colon time,reaching transverse colon time,reaching descending colon time);(2)Plasma levels of gastrointestinal hormones(MOT?GAS?VIP?SS)1 day before surgery,1 day after surgery and 7 days after surgery;(3)postoperative discomfort related Complications:(nausea,vomiting,abdominal pain,bloating).2 Experimental StudyEighty rats were used to establish a gastrectomy trauma model,and random codes were generated by software to randomly divide them into 4 groups:sham operation group,standard enteral nutrition group,enteral immune nutrition group,and Qihuang decoction group,20 cases in each group.(1)The intestine of Qihuang decoction is given by instillation in the small intestine(the same below),and the phenol red emptying method is used to calculate the small intestine with the formula(small intestine advancing rate=advancing length/small intestine full length×100%)Advancing rate.(2)Through immunofluorescence labeling and laser scanning confocal microscopy,observe the morphology and distribution of Ach?SP?VIP?and NO-in the small intestine ENS network;the number of Ach?SP?VIP?and NO neuronal cells.(3)Real-time fluorescence quantitative reverse transcription-polymerase chain reaction(RT-PCR)method was used to detect the mRNA expression level and observe the transcription of AchE?SP?VIP?and NOS genes;The post-transcriptional AChE?SP?VIP?NOS protein translation was detected.(4)The expression of M3R?VIP2R?and NK1R genes was detected by real-time fluorescence quantitative RT-PCR;the protein translation of M3R,VIP2R,and NK1R was detected by Western blot.Results1 Clinical research(1)Gastrointestinal motility recovery time(bowel sounds recovery time,anal exhaust defecation time?resumed feeding time?contrast medium arrival time to ascending colon?time to transverse colon?and time to descending colon)in the study group The group was significantly shortened(both P<0.05);(2)Comparison of gastrointestinal motility promoting hormones between the two groups:The GAS in the study group was significantly higher than that in the control group(P<0.05),7 days after the operation,the MOT in the study group was significantly higher than that in the control group;The levels of MOT and GAS in the two groups were significantly lower on the first day after operation(P<0.05),and those in the control group were still significantly lower on the seventh day after operation(P<0.05),while those in the study group were not significantly lower on the seventh day after operation(P>0.05).The comparison of the two groups in inhibiting gastrointestinal motility hormone after operation:On the 1 st and 7th day after operation,VIP and SS in the study group were lower than those in the control group,The difference between the two groups was statistically significant(P<0.05).The VIP and SS in the control group were significantly higher than those in the preoperative group(P<0.05).The VIP and SS in the study group were not significantly higher than those in the preoperative group(P>0.05).(3)Compared with the control group,Qihuang decoction can reduce postoperative abdominal distension and abdominal discomfort,the difference is significant(P<0.05),and there is no difference in the number of nausea and vomiting between the two groups(P>0.05).2.Experimental research(1)It was found in the small bowel advancing motor function test that the postoperative small bowel advancing rate in the standard enteral nutrition group,enteral immune nutrition group?and Qihuang decoction group were all lower than those in the sham operation group(P<0.05).Compared with the standard enteral nutrition group and the enteral immune nutrition group,the small bowel advancing rate in the group was significantly improved,and the difference was significant(P<0.05).(2)In the experiment of observing the structure of the ENS network,it was found that the ACH and SP intestinal neurons in the Qihuang decoction group were large and deep stained,and the nerve fibers in the intersegment bundle were thick,which was comparable to the staining and distribution of the sham operation group.Standard enteral nutrition The cell bodies of the group and intestinal immune nutrition group were relatively small,and the intersegmental bundle nerve fiber slender staining was lighter;the Qihuang decoction group was smaller in VIP and NO enteric neuron cell body neuron cell body,and the intersegmental bundle nerve fiber slender staining was lighter,Compared with the sham operation group,the staining and distribution were similar.The standard enteral nutrition group and the enteral immune nutrition group had relatively deep cell bodies and large intersegmental nerve fibers.(3)In the experiment of observing the number of ENS network-positive neurons,it was found that compared with the sham operation group,the standard enteral nutrition group and the immune nutrition group were significantly reduced,and the difference was significant(P<0.05).Qihuang decoction group did not decrease significantly,P>0.05(values were P=0.2930,0.5039,0,2800,0.0005);enteral immune nutrition group and Qihuang decoction group increased significantly compared with standard enteral nutrition group,both P<0.005(values are P=0.2930,0.5039,0.2800,0.0005).(4)In the experiments on the effects of intestinal neurotransmitters on the ENS network,it was found that the expression of ACNE,?SP?M3R/NKIR mRNA and protein was significantly reduced in the standard enteral nutrition group compared with the sham operation group(P<0.05).Qihuang Decoction The AChE?SP?M3R?NK1R mRNAs in the group were also significantly reduced,while VIP?NOS and VIP2R were significantly increased(P<0.05);the AChE?SP?M3R?and NK1R were compared between the Qihuang decoction group and the immune enteral nutrition group and the standard nutrition group.The mRNA and protein expressions were significantly increased(P<0.05),The expressions of VIP?NOS?VIP2R mRNA and protein were significantly reduced(P<0.05).Conclusion(1)Trauma of surgery and stress of anesthesia can cause cholinergic nerve function damage,affect the number of corresponding positive neurons in ENS,and cause gastrointestinal motor dysfunction;(2)Early application of Qihuang decoction after gastrectomy can reduce postoperative discomfort and complications and promote small bowel peristalsis;(3)Qihuang decoction can effectively regulate gastrointestinal hormones(MOT?GAS?VIP?SS),so that it can return to normal as soon as possible after surgery;(4)Qihuang decoction can help the reconstruction and recovery of ENS network,and promote the enhancement of intestinal motility;(5)Qihuang decoction can effectively regulate the number of corresponding positive neurons in ENS and the expression of ACh?SP?VIP?nNOS?M3R?VIP2R?NK1R mRNA and protein.(6)The early application of Qihuang decoction in the small intestine after gastrectomy is beneficial to the recovery of intestinal ENS after surgery,promotes gastrointestinal movement,facilitates absorption of nutrients in the gastrointestinal tract,and improves immune function.