Ilhan Yavuz Selim, Bulbuller Nurullah, Kirkil Cuneyt, Ozercan Resat, Seckin Dilara
Department of General Surgery, Medical Faculty of Firat University, Elaziĝ, Turkey.
J Surg Res. 2005 Sep;128(1):61-5. doi: 10.1016/j.jss.2005.03.001.
Dehiscence of intestinal anastomosis is associated with high mortality and morbidity rates. Angiotensin II is a potent agent in the acceleration of wound repair. Angiotensin converting enzyme (ACE) inhibitors have antifibrogenic effects.
This study was performed to investigate the effect of ACE inhibitors on healing of intestinal anastomosis.
Forty-five male Wistar albino rats were divided into three groups. Ileum was divided above 10 cm from ileocecal valve after laparotomy and a single-layer ileoileal anastomosis was performed. While no treatment was given to rats in group 1, Lisinopril (an ACE inhibitor) was given to rats in group 2 and group 3 for post-operative 7 days in drinking water at 50 and 5 mg/l concentrations, respectively. Estimated amounts of supplied lisinopril were 6.5 and 0.65 mg/kg/day in groups. On post-operative 8th day, relaparotomy was performed and anastomosis-bursting pressures were measured. Then blood and tissue samples were taken for serum transforming growth factor beta-1 and tissue hydroxyproline measurements and histopathological examinations.
High dose of lisinopril impaired the all parameters of anastomotic wound healing including bursting pressure, tissue hydoxyproline level, collagen deposition and epithelization (P < 0.001, group 2 versus groups 1 and 3). But low dose of lisinopril had no effect on those parameters (P > 0.05, group 1 versus group 3).
It was concluded that lisinopril has impaired intestinal wound healing in a dose dependent manner and low doses of lisinopril can be safely used on patients with intestinal anastomosis.
肠吻合口裂开与高死亡率和发病率相关。血管紧张素II是加速伤口修复的强效因子。血管紧张素转换酶（ACE）抑制剂具有抗纤维化作用。
本研究旨在探讨ACE抑制剂对肠吻合口愈合的影响。
45只雄性Wistar白化大鼠分为三组。剖腹术后在距回盲瓣上方10 cm处切断回肠，并进行单层回肠-回肠吻合。第1组大鼠不接受任何治疗，第2组和第3组大鼠分别在术后7天饮用含50 mg/l和5 mg/l赖诺普利（一种ACE抑制剂）的水。两组中供应的赖诺普利估计量分别为6.5 mg/kg/天和0.65 mg/kg/天。术后第8天再次剖腹，测量吻合口破裂压力。然后采集血液和组织样本，用于检测血清转化生长因子β-1和组织羟脯氨酸，并进行组织病理学检查。
高剂量赖诺普利损害了吻合口伤口愈合的所有参数，包括破裂压力、组织羟脯氨酸水平、胶原沉积和上皮形成（第2组与第1组和第3组相比，P < 0.001）。但低剂量赖诺普利对这些参数无影响（第1组与第3组相比，P > 0.05）。
得出结论，赖诺普利以剂量依赖方式损害肠伤口愈合，低剂量赖诺普利可安全用于肠吻合患者。
