Cullen J J, Eagon J C, Kelly K A
Department of Surgery and the Gastroenterology Research Unit, Mayo Clinic, Rochester, MN 55905.
Dig Dis Sci. 1994 Jun;39(6):1179-84. doi: 10.1007/BF02093781.
The hypothesis was that postoperative ileus might be caused by a disturbed balance between the motor-stimulating hormones, motilin and substance P, and the motor-inhibitory hormone, vasoactive intestinal polypeptide, and that octreotide might prevent this disturbance and so ameliorate the ileus. In 15 conscious dogs with chronic gastrointestinal electrodes, electrical activity was recorded and blood was drawn for radioimmunoassay of motilin, substance P, and vasoactive intestinal peptide (VIP) during fasting and after a liquid meal. Ileus was then induced by celiotomy and intestinal abrasion. During and after operation, five dogs received 154 mM NaCl only, five dogs octreotide, 0.19 micrograms/kg/hr, and five octreotide, 0.83 micrograms/kg/hr. Plasma levels of motilin, substance P, and VIP were changed little by operation, but cyclical increases in plasma motilin, which occurred preoperatively during phase III of the interdigestive myoelectric complex, were completely abolished postoperatively during ileus, as was the complex itself. Octreotide ameliorated the ileus and restored the cyclic increases in motilin found in health, nor did it alter plasma substance P and VIP. In conclusion, octreotide ameliorates postoperative ileus, but it does not do so by increasing plasma motilin or substance P or decreasing plasma VIP.
研究假设为，术后肠梗阻可能是由促动力激素胃动素和P物质与抑制动力的激素血管活性肠肽之间的平衡紊乱所致，而奥曲肽可能预防这种紊乱，从而改善肠梗阻。对15只植入慢性胃肠电极的清醒犬，在禁食期间及给予流食后记录其电活动，并采集血液用于放射免疫法检测胃动素、P物质和血管活性肠肽（VIP）。然后通过剖腹术和肠擦伤诱导肠梗阻。手术期间及术后，5只犬仅接受154 mM NaCl，5只犬接受0.19微克/千克/小时的奥曲肽，5只犬接受0.83微克/千克/小时的奥曲肽。手术对胃动素、P物质和VIP的血浆水平影响不大，但术前在消化间期肌电复合波的Ⅲ期出现的血浆胃动素周期性升高在术后肠梗阻期间完全消失，该复合波本身也是如此。奥曲肽改善了肠梗阻，并恢复了健康状态下出现的胃动素周期性升高，且未改变血浆P物质和VIP水平。总之，奥曲肽可改善术后肠梗阻，但并非通过升高血浆胃动素或P物质水平或降低血浆VIP水平来实现。
