| Bowel dysfunction has gradually become an important factor in themental and physical health of the patients with spinal cord injury. Clinicallyrelevant signs and symptoms as well as complications are constipation, fecalincontinence, autonomic dysreflexia, intestinal barrier damage. In seriouscases, it will also appear bacterial translocation and endotoxemia, increasingsystemic inflammatory response syndrome and multiple organ dysfunctionsyndrome incidence. Traditional treatment methods mainly include diet,lifestyle changes, medication, as well as behavior and biofeedback therapy.Surgical treatment including colostomy, ileostomy, Malone AntegradeContinence Enema and sacral nerve stimulator transplantation. Among them,the sacral nerve stimulation has become one of the most popular researchdirection. Sacral nerve electrical stimulation can promote colon peristalsis andincrease colon rectum pressure, to restore the normal bowel function, reducethe damage to the intestinal mechanical barrier and decrease bacterialtranslocation and endotoxemia incidence. But sacral never stimulating onprotecting intestinal mechanical barrier in rats with acute complete spinal cordinjury has not been elucidated. This experiment aims to preliminary studysacral nerve electrical stimulation on protecting intestinal mechanical barrierin rats with acute complete spinal cord injury.Objective: The first phase experiment: investigate the effect of differentsacral never stimulating voltage on bowel after spinal cord injury in rats toobtain the best stimulating parameters. The second phase experiment: usingthe best parameter to study the impact of sacral3nerve root stimulation onintestinal mechanical barrier in rat with acute complete spinal cord injury. Todeclare the pathophysiological mechanism of bacterial translocation, endotoximia and sacral never stimulating on protecting intestinal mechanicalbarrier in rats with acute complete spinal cord injury. To provide theoreticalbasis and new ideas for clinical treatment．Methods: The first phase experiment: regarding sham group as normalgroup, regarding acute complete spinal cord injury group as control group,regarding sacral nerve stimulation group as experimental group. According toFehlings’ method，we used the aneurysm clip and transected the spinalcord．We started the stimulation from the low intensity to high untill the tailand leg got shiver(threshold)．On the basis, we stimulated in four intensity(1V,2V,4V,8V)，then frequence of15Hz，and the pulse of210μs．The stimulationperiod was2hours， with10minutes stimulation and10minutes restintermittently，two times per day at8：00-10：00am and6：00-8：00pm. Thenwe observed and recorded the colon myoelectric activity waveforms peakvalue at different sites of colon in different stimulation parameter to obtain thebest stimulation parameter. The second phase experiment: regarding shamgroup as normal group, regarding acute complete spinal cord injury group ascontrol group, regarding the best stimulation parameter group as experimentalgroup. We respectively procesed endotoxin detection, bacteria cultivation ofintestinal lymph nodes, liver, spleen, intestinal morphology observation,protein expression detection of ZO-1for each group. Analysis the protectiveeffect mechanism of sacral nerve stimulation on intestinal mechanical barrier,endotoxemia and bacterial translocation in the rat with acute complete spinalcord injury.Results:1The first phase experiment: the colon myoelectric activity waveformspeak value of experimental group and control group were lower than normalgroup. But the colon myoelectric activity waveforms peak value ofexperimental group were higher than control group.2The second phase experiment: we can observe retention of urine,abdominal distension and constipation after the spinal cord transected．Wepaunched the abdomens and found intestinal tympanites obviously， transmission of light of intestinal wall strengthened，and intestinal peristalsisslow down．A lot of stool was accumulated in the cecum，colon，andrectum．The intestinal mucosa appeared different degree of damage; cellconnection between intestinal epithelial cells appeared dissolved, missing;Endotoxin levels, content and the number of bacterial translocation inunceasing increase. We found sacral nerve stimulation rehabilitated theperistalsis of denervated colon and the compatibility of anorectal canal,improved the defecation, reduced the endotoxin content in the blood to normallevel and the incidence rate of the gut origin bacterial translocation by thestimulation parameters of our trial.3The expression of tight junction protein ZO-1of rat intestinal tissue hadno statistical differences among normal group, control group and experimentalgroup. But we found that the distribution of tight junction protein ZO-1appeared different degrees of scattered, irregular in control group, and theexperimental group appeared different degrees of improvement in theimmunohistochemical of rat intestinal tissue with the time extending.Conclusion:1Different sacral never stimulating voltage could improve bowelfunction in rats with acute complete spinal cord injury. The best stimulatingvoltage are4V.2The rats with acute complete spinal cord injury appeared urinaryretention and bowel dysfunction such as abdominal distension, bilge gas,transmission of light of intestinal wall strengthening, a large number of stoolwas accumulation, bradydiastalsis.3The intestinal mechanical barrier such as intestinal epithelial cells andtight junction appeared different degree of damage and made endotoxin levels,and incidence of bacterial translocation increase.4Sacral3nerve root stimulation can rehabilitate the peristalsis ofdenervated colon, promote defeacation and decrease bacterial amount. Theintestinal mechanical barrier such as intestinal epithelial cells and tight junction appeared different degree of improvement, reduced the endotoxincontent in the blood to normal level and the incidence of the gut originbacterial translocation. |
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