Department of Surgery, Surgical Physiopathology Laboratory (LIM-62), School of Medicine, University of São Paulo, Brazil.
Department of Surgery, Surgical Physiopathology Laboratory (LIM-62), School of Medicine, University of São Paulo, Brazil.
Int J Surg. 2014;12(6):594-600. doi: 10.1016/j.ijsu.2014.04.007. Epub 2014 May 4.
Intestinal obstruction is an abdominal disease associated to mortality, especially if complicated with sepsis. Resuscitation increases survival, although controversies remain concerning to therapeutic strategy.
To assess the effects of hypertonic saline and pentoxifylline on the inflammatory response and oxidative stress, Wistar rats underwent a laparotomy loop intestinal obstruction and ischemia. After 24 h, the intestinal segment was resected (IO) without any other treatment and resuscitation/pentoxifylline were administered according to the group: Ringer's lactate (RL); hypertonic saline (HS); pentoxifylline (PTX); Ringer's lactate with pentoxifylline (RL + PTX); hypertonic saline with pentoxifylline (HS + PTX) and the control group (CG) that was not submitted to ischemia and obstruction. Mean arterial pressure (MAP) was recorded 4 times, and euthanasia was done 3 h after the resuscitation to obtain lung tissue, for malondialdehyde (MDA) by thiobarbituric acid reactive substances (TBARS) method, inflammatory cytokines were assessed using ELISA and NF-κΒ by Western blotting.
The initial MAP levels were higher in the RL and HS groups than in the others; however, the last measurement was similar among all the groups. IL-1β, IL-6 and CINC-1 (Cytokine-Induced Neutrophil Chemoattractant-1) were lower in the HS, PTX and HS + PTX groups compared with the IO and RL groups. IL-10 was lower in the HS + PTX group than in the IO group. NF-κB in the HS, PTX and HS + PTX groups were lower than in the IO group; NF-κB in the HS + PTX group was lower than in the RL group. MDA in the lung was lower in the HS + PTX group compared with other groups.
Hypertonic saline and pentoxifylline, both alone and in combination, attenuated oxidative stress and the activation of NF-κB, leading to a decrease in the inflammatory response.
肠梗阻是一种与死亡率相关的腹部疾病，尤其是如果伴有感染性休克的话。复苏可以提高生存率，但关于治疗策略仍存在争议。
为了评估高渗盐水和己酮可可碱对炎症反应和氧化应激的影响，Wistar 大鼠接受了剖腹术肠袢肠梗阻和缺血。24 小时后，不进行任何其他治疗，切除肠段（IO），并根据以下组进行复苏/己酮可可碱治疗：乳酸林格氏液（RL）；高渗盐水（HS）；己酮可可碱（PTX）；RL 加己酮可可碱（RL+PTX）；HS 加己酮可可碱（HS+PTX）和对照组（CG），即未进行缺血和梗阻。记录平均动脉压（MAP）4 次，复苏后 3 小时行安乐死，获取肺组织，采用硫代巴比妥酸反应物质（TBARS）法测定丙二醛（MDA），酶联免疫吸附法（ELISA）测定炎症细胞因子，Western blot 法测定 NF-κΒ。
RL 和 HS 组的初始 MAP 水平高于其他组，但最后一次测量在所有组之间相似。与 IO 和 RL 组相比，HS、PTX 和 HS+PTX 组的 IL-1β、IL-6 和 CINC-1（细胞因子诱导的中性粒细胞趋化因子-1）水平较低。与 IO 组相比，HS+PTX 组的 IL-10 水平较低。与 IO 组相比，HS、PTX 和 HS+PTX 组的 NF-κB 较低；与 RL 组相比，HS+PTX 组的 NF-κB 较低。与其他组相比，HS+PTX 组的肺 MDA 较低。
高渗盐水和己酮可可碱单独或联合使用均可减轻氧化应激和 NF-κB 的激活，从而降低炎症反应。
