Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-07-05 Cooperative journals: 《中国全科医学》
Abstract： Background Postoperative sore throat （POST） is one of the common mild but unpleasant postoperative complications after general anaesthesia. There is evidence that Glycyrrhiza Radix can effectively reduce the incidence of POST，but its effective fraction remains unclear. Objective To screen the effective fraction of Glycyrrhiza Radix on preventing respiratory tract injury induced by endotracheal intubation. Methods From April 2021 to July 2022，60 SPF-grade Wistar rats were randomized into the control group，endotracheal intubation group，lidocaine group，total polysaccharides group，total saponins group，total flavonoids group based on random number table method，with 10 rats in each group. The endotracheal intubation model was prepared for all groups except the control group. Before intubation，each treatment group was sprayed with a solution consisting of 1% lidocaine，total polysaccharides，total saponins，and total flavonoids at 1 mL/100 g（by body weight）to permeate the uvula and peri-soft palate tissue of rats，respectively. The control and endotracheal intubation groups were sprayed with an equal volume of 0.9% saline. After 2 hours of mechanical ventilation，the endotracheal tube was removed，and the pharyngeal mucosa tissues and blood samples of rats were collected under deep anesthesia. Pathological changes of rat pharyngeal mucosa and the expression levels of Toll-like receptor 2 （TLR2） and Toll-like receptor 4 （TLR4） were observed by hematoxylin-eosin staining （HE staining） and immunohistochemistry （IHC）; the expression levels of inflammatory cytokines including serum tumor necrosis factor-α （TNF-α），interleukin-2（IL-2），interleukin-4（IL-4），interleukin-10（IL-10），superoxide dismutase（SOD），malondialdehyde（MDA），total antioxidant capacity（T-AOC），and stress hormones including cortisol（Cor），epinephrine （E），and norepinephrine（NE） were measured by enzyme-linked immunosorbent assay （ELISA）. Results HE staining showed mucosal shedding and severe damage of submucosal structure accompanied by a large number of inflammatory cells infiltrated in the endotracheal intubation group; while milder damage of mucosal structure and less inflammatory cells were significantly reduced in the total saponins group. ELISA results showed that compared with the control group，the levels of TNF-α and IL-2 in the serum of rats increased significantly，and the levels of IL-4 and IL-10 decreased significantly in the endotracheal intubation group （P<0.05）; compared with the endotracheal intubation group，the serum levels of TNF-α and IL-2 decreased，and the levels of IL-4 and IL-10 increased in the total saponins group（P<0.05）. Compared with the control group，the MDA level in the serum of rats was significantly increased，and the SOD and T-AOC levels were significantly decreased in the endotracheal intubation group（P<0.05）; compared with the endotracheal intubation group，the MDA level decreased and the levels of SOD and T-AOC increased in the total saponins and flavonoids groups（P<0.05）. Compared with the control group，serum Cor，E，and NE levels significantly increased in the endotracheal intubation group （P<0.05）; compared with the tracheal intubation group，serum Cor，E and NE levels were decreased in the total saponins group rats （P<0.05）. The IHC results showed that the average optical density （AOD） expressed by TLR2 and TLR4 in the endotracheal intubation group was higher than the control group（P<0.05）. The AOD expressed by TLR4 in the pharyngeal mucosal tissue of rats in the total saponins group was significantly lower than that of the endotracheal intubation group（P<0.05）. Conclusion Total saponin is the main effective fraction of Glycyrrhiza Radix for the prevention of respiratory tract injury caused by endotracheal intubation under general anesthesia.
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