Effects Of Intestinal Motility Changes On Organ Injuries In Rabbits Posterior To Serious Thoraco-abdominal Injury

Gastrointestinal function disturbance posterior to trauma and shock is a important clinical problem, it related to: gastrointestinal motility disturbance, ischemic and hypoxia injury on gastrointestinal mucosa, destruction of gut barrier function, translocation of bacterium and endotoxin, all of above could lead to systemic inflammatory response syndrome or systemic infection, even multiple organ dysfunction syndrome, prognosis should be influenced greatly. Studies indicated that prokinetic drugs are helpful to improve barrier function of small intestine. Thus, studies on intestinal function disturbance and gastrointestinal ischemic injury posterior to serious thoraco-abdominal injury and effects of prokinetics on these injuries have remarkable meaning to reduce complications after trauma. In this study, we established rabbit experimental model of thoraco-abdominal injury, movement and permeability of the small intestine, bacteria translocation, gastrointestinal ischemic status, function changes of liver and morphological change of liver, stomach and small intestine mucosa were measured under trauma and stress condition, to discuss effects of intestinal motility changes on organ injuries posterior to serious thoraco-abdominal injury, and prokinetic-mosapride was used to investigate effects of prokinetic drug on function and structure of gastrointestinal tract and other organs, results could be used for reference by clinical therapy. The study has been processed in 2 stages: 1) observation of gastrointestinal disfunction and ischemia injury after severe thoraco-abdominal injury in rabbits; 2) Effects of prokinetics –mosapride on gastrointestinal function and ischemia in early stage of severe thoraco-abdominal injury in rabbits. The main results and conclusions are as following: 1. 2h-8h after severe thoraco-abdominal injury, in trauma group, a function disturbance of small intestine transit could be observed(P<0.01). Intestinal permeability and positive rate of portal vein blood culture increased obviously(P<0.01); portal venous blood flow decreased(P<0.01); lactic acid concentration of portal venous and peripheral vein increased significantly(P<0.01); serum alanine aminotransferase and aspartate aminotransferase increased abnormally(P<0.01). There were no significant changes in serum total protein, and albumin. Obvious pathological changes emerged in liver, stomach and intestine. 2. Mosapride could promoting intestinal transit(P<0.01), decreasing intestinal permeability(P<0.05), increasing gastrointestinal blood flow(P<0.05), depressing lactic acid level of portal venous and peripheral vein(P<0.01), reducing the damage of liver function and abating side pathological changes of liver and gastrointestinal tract. But no obvious changes in positive rate of portal vein blood culture, level of serum total protein and albumin. Through this study, we conclude that gastrointestinal function disturbance after severe thoraco-abdominal injury include gut barrier function disturbance and gastrointestinal motility disturbance. Gastrointestinal tract ischemia perhaps is one of important reasons of other gastrointestinal function disturbance. It suggests that after making up effective circulating blood volume for sever injuries, an earlier utility of mosapride for treatment of gastrointestinal motility is helpful for an improvement of lasting ischemia and hypoxia in viscera like gastrointestinal tract after resuscition.