| Objective:This thesis explores the Effects and possible mechanism of the postoperative rabbit’s microvascular albumin leakage and intervene by Hydroxyethyl starch, observing the phenomenona of the early postoperative mesentery microvascular albumin leakage and the change of endothelial gaps in the mesentery, as well as testing the leakage rate of mesentery microvascular albumin and Hydroxyethyl starch, the concentration of serum albumin and the serum inflammation mediators on the rabbits with abdominal surgery.Methods:Fifty-four Japanese big-eared rabbits were randomly divided into the control group (six rabbits), the physiologica saline group (6h,24h,48h,72h, six ones each group) and the hydroxyethyl starch group (6h,24h,48h,72h, six ones each group).The control group did not undergo the surgery while the treatment group received subtotal gastrectomy and distal pancreatectomy with splenectomy. All the postoperative rabbits were nourished by equal calorie and nitrogen per kilogram of body weight. Glucose and fat offered 70% and 30% of the calories respectively. The ratio of nitrogen and calorie was 1:130. After the technique the physiological saline group rabbit gives the physiological saline 25ml/kg every day, the ethylol starch group rabbit gives 6% HES(130/0.4)25ml/kg every day to test time. In preoperative and postoperative 6h,24h,48h,72h for blood tests:The concentration of serum albumin, IL-6,TNF-α,IL-2,ICAM-1,VEGF and HIS.With mainlining RBITC labeled BSA, with TITC labeled HES, the physiologica saline group postoperative (6h,24h,48h,72h) inject RBITC-BSA, then observe mesentery microvascular albumin leakage of the rabbit by laser sacanning confocal microscope afer 2 minutes and its microvascular serum albumin leakage ratio was calculated; the hydroxyethyl starch group postoperative (6h,24h,48h,72h) inject TITC-HES firstly, then observe mesentery microvascular hydroxyethyl starch leakage of the rabbit by laser sacanning confocal microscope afer 2 minutes and its microvascular hydroxyethyl starch leakage ratio was calculated; then inject RBITC-BSA secondly,observe mesentery microvascular albumin leakage of the rabbit by laser sacanning confocal microscope afer 2 minutes and its microvascular serum albumin leakage ratio was calculated;Detecte the change of endothelial gaps in microvascular of the mesentery of the control group,the physiologica saline group postoperative 48h, and the hydroxyethyl starch group postoperative 48h through transmission electron microscope.Results:1. The change of serum albumin concentration:①Comparison within each physiologica saline group:There was a signiicant difference between the preoperative and the postoperative (6h,24h,48h,72h) concentration (P< 0.01).and the concentration came to the minimum in postoperative 48h.② Comparison within each hydroxyethyl starch group:There was a signiicant difference between the preoperative and the postoperative (6h,24h,48h,72h) concentration (P<0.01). and the concentration came to the minimum in postoperative 48h.③Comparision between the physiologica saline and the hydroxyethyl starch groups:There was a signiicant difference between them in (6h,24h,48h,72h) concentration (P<0.01).2. The comparison of the serum inflammation mediators:(1) Serum IL-6:① Comparison within each physiologica saline group:There was a significant difference between the preoperative and the postoperative (6h,24h,48h,72h) concentration (P<0.01).②Comparison within each hydroxyethyl starch group: There was a signiicant difference between the preoperative and the postoperative (6h,24h,48h,72h) concentration (P<0.01).③Comparision between the physiologica saline and the hydroxyethyl starch groups:There was a signiicant difference between them in (6h,24h,48h,72h) concentration (P<0.01).(2) Serum TNF-α:①Comparison within each physiologica saline group:There was a signiicant difference between the preoperative and the postoperative (6h, 24h,48h,72h) concentration (P<0.01).②Comparison within each hydroxyethyl starch group:There was a significant difference between the preoperative and the postoperative (24h,48h,72h) concentration (P<0.01) but no significant difference between the preoperative and the postoperative (6h) concentration (P>0.05)③Comparision between the physiologica saline and the hydroxyethyl starch groups:There was a signiicant difference between them in (6h,24h, 48h,72h) concentration (P<0.01). (3) Serum IL-2:①Comparison within each physiologica saline group:There was a significant difference between the preoperative and the postoperative (6h,24h,48h,72h) concentration (P<0.01).② Comparison within each hydroxyethyl starch group:There was a significant difference between the preoperative and the postoperative (6h,24h,48h,72h) concentration (P<0.01).③Comparision between the physiologica saline and the hydroxyethyl starch groups:There was a significant difference between them in (6h,24h) concentration (P<0.01). There was a significant difference between them in (72h) concentration (P<0.05) but no significant difference between the preoperative and the postoperative (48h) concentration (P>0.05) (4) Serum ICAM-1:① Comparison within each physiologica saline group:There was a significant difference between the preoperative and the postoperative (6h,24h, 48h,72h) concentration (P<0,01).②Comparison within each hydroxyethyl starch group:There was a signiicant difference between the preoperative and the postoperative (6h,24h,48h,72h) concentration (P<0.01).③Comparision between the physiologica saline and the hydroxyethyl starch groups:There was a signiicant difference between them in (6h,24h,48h,72h) concentration (P<0.01).(5) Serum VEGF: ① Comparison within each physiologica saline group:There was a significant difference between the preoperative and the postoperative (6h,24h, 48h,72h) concentration (P<0.01).②Comparison within each hydroxyethyl starch group:There was a signiicant difference between the preoperative and the postoperative (24h,48h,72h) concentration (P<0.01) but no significant difference between the preoperative and the postoperative (48h) concentration (P>0.05).③Comparision between the physiologica saline and the hydroxyethyl starch groups:There was a signiicant difference between them in (6h,24h, 48h,72h) concentration (P<0.01).(6) Serum HIS:① Comparison within each physiologica saline group:There was a significant difference between the preoperative and the postoperative (6h,24h, 48h,72h) concentration (P<0.01).②Comparison within each hydroxyethyl starch group:There was a signiicant difference between the preoperative and the postoperative (6h,24h,48h,72h) concentration (P<0.01).③Comparision between the physiologica saline and the hydroxyethyl starch groups:There was a significant difference between them in (6h,24h,48h) concentration (P<0.01). There was a significant difference between them in (72h) concentration (P< 0.05).3. The comparison of the leakage rate of the rabbit’s mesentery micro vascular:① Comparison between physiologica saline group and hydroxyethyl starch groups: There was a signiicant difference in (6h,24h,48h,72h) albumin leakage rate (P< 0.01);②Comparison within hydroxyethyl starch groups:There was a signiicant difference between the albumin leakage rate and hydroxyethyl starch leakage rate in (6h,24h,48h,72h) (P<0.01).4. The change of mesentery microvascular endothelial gaps:In the control group, the membrane of endothelial cell was integrated and tightly jointed in microvascular. In the hydroxyethyl starch group the membrane of endothelial cell was integrated and jointed almost in microvascular., about 0.1 μm cell fissure appeared in normally tight junctions between the endothelial cells. In the physiologica saline group, the membrane of endothelial cell was not integrated, there was an obvious cell swelling in microvascular and about 0.2-0.3μm cell fissure appeared in normally tight junctions between the endothelial cells.Conclusion:1.After the rabbit abdominal surgery early, the concentration of serum albumin declined and came to the minimum in postoperative 48h. the use of hydroxyethyl starch (130/0.4) can decrease of plasma lead albumin concentration reduced.2. A major abdominal surgery early has the phenomenon which inflammatory mediators such as Interleukin-6 and tumor necrosis factor-alpha, interleukin-2, intercellular adhesion molecule-1 and vascular endothelial growth factor, histamine concentration increased; The postoperative use of hydroxyethyl starch can reduce the concentration of interleukin -6, tumor necrosis factor alpha, interleukin -2, intercellular adhesion molecule -1, vascular endothelial growth factor, but cannot suppress the histamine (HIS) density ascension.3. Through laser sacanning confocal microscope, postoperative microvascular albumin and hydroxyethyl starch leakage was observed and the leakage ratio peaked in 48h. But hydroxyethyl starch leakage was less than the leakage of albumin.After major abdominal surgery using hydroxyethyl starch may relieve mesentery microvascular albumin leakage.4. Under electron microscopy, After major abdominal surgery the opening of the microvascular endothelial gap was found,but using hydroxyethyl starch may relieve the opening of the microvascular endothelial gap. |
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