Objective To investigate the effects of propofol on gastric mucosal blood flow(GMBF), nitric oxide(NO) and endothelin(ET), and to confirm the role and mechanism of propofol in the gastric mucosal injury after trauma hemorrhagic shock resuscitation in rabbits.Methods Seventy-five healthy adult male rabbits were randomly divided into 5 groups of 15 rabbits: control(S group), trauma hemorrhagic shock resuscitation gastric mucosal injury(M group) and 10 min before hemorrhage(P1 group), 10 min before resuscitation(P2 group), 20 min after resuscitation(P3 group) application propofol group [5 mg/kg propofol was injected intravenously, then 20 mg/(kg·h) was infused].The S and M groups were given the same amount of saline.The GMBF was detected by laser Doppler flowmetry.The gastric tissue samples were obtained at 90 min after resuscitation.Gastric mucosal damage index(DI) was calculated by Guth method.The contents of NO and ET-1 were determined by nitrate reductase and radioimmunoassay respectively.The NO/ET-1 ratio was calculated and the correlation between GMBF and NO/ET-1 ratio and between DI value and GMBF, NO, ET-1 or NO/ET-1 ratio was observed.Results ①Compared with group S, the GMBF, NO and NO/ET-1 ratio were significantly lower, while DI and ET-1 were significantly high after resuscitation in group M and group P(P<0.05 or P<0.01).②The GMBF at 30 min and 90 min after resuscitation in group P1, P2 and that at 90 min after resuscitation in group P3 were significantly higher, and NO content and NO/ET-1 ratio in group P1, P2 or P3 were significantly higher, but DI and ET-1 content in group P1, P2 or P3 were significantly lower than those in group M(P<0.05 or P<0.01).③The GMBF at 90 min after resuscitation and NO/ET-1 ratio were significantly higher, but DI was significantly lower in group P1 than in group P3(P<0.05 or P<0.01).④At 90 min after resuscitation, there was a close correlation between GMBF and NO/ET-1, DI and GMBF, NO or NO/ET-1, DI and ET-1(r=0.913,-0.699,-0.762,-0.678 and 0.705 respectively, P<0.01).Conclusion Propofol can improve NO and ET-1 balance, raise NO/ET-1 ratio and is beneficial to maintaining GMBF.Propofol can also reduce the gastric mucosal injury after trauma hemorrhagic shock resuscitation in rabbits;it is of great effectiveness when being applied before ischemia.%目的 探讨异丙酚对兔创伤失血性休克复苏胃黏膜损伤(trauma hemorrhagic shock resuscitation-gastric mucosal injury,THSR-GMI)及其血流量和一氧化氮(NO)/内皮素-1(ET-1)的影响,以确定异丙酚对THSR-GMI的作用及机制.方法 成年雄性新西兰大白兔75只随机分为:对照组(S)、模型组(M)及失血前(P1)、复苏前(P2)和复苏后(P3)应用异丙酚组,每组15只.除S组外均以股骨粉碎骨折并放血法制备THSR-GMI模型.P1、P2和P3组分别于放血前、复苏前10 min及复苏后20 min静注异丙酚5 mg/kg,后以20 mg/(kg·h)持续静脉输注.而S组和M组给予等量生理盐水.用激光多普勒血流仪监测胃黏膜血流量(GMBF);于复苏90 min 时取胃黏膜组织,参照Guth方法计算胃黏膜损伤指数(DI)、用硝酸还原酶法和放射免疫法分别测定NO和ET-1含量,计算NO/ET-1,并观察GMBF与NO/ET-1及DI值与GMBF、NO、ET-1及NO/ET-1的相关性.结果 ①与S组比较,M组及P组复苏后各时点的GMBF及胃黏膜NO、NO/ET-1显著降低,而DI和ET-1则显著升高(P<0.05或P<0.01);②与M组比较,P1和P2组于复苏30、90 min 及P3组复苏90 min 时GMBF较高,P1、P2和P3组NO、NO/ET-1较高,但其DI和ET-1较低(P<0.05或P<0.01);③与P3组比较,P1组复苏90 min 时GMBF及其NO/ET-1较高,而DI值较低(P<0.05或P<0.01);④复苏90 min时,GMBF与NO/ET-1呈正相关,DI值与GMBF、NO及NO/ET-1均呈负相关,而与ET-1呈正相关(P<0.01). 结论 异丙酚可改善创伤失血性休克复苏胃黏膜组织NO与ET-1平衡,提高NO/ET-1比值,有利于维持GMBF,减轻胃黏膜损伤,以失血前应用效果更佳.
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