CAJ | 학술논문

目的探讨高张溶液复苏对"失血性休克-内毒素"二次打击所致肺和血管内皮细胞损伤的影响.方法将62只SD大鼠随机分为假失血性休克组(Sham组)、乳酸钠林格氏液/6%羟乙基淀粉液复苏组(RLH组)和7.5%氯化钠溶液/6%羟乙基淀粉溶液复苏组(HTH组).RLH和HTH组复制大鼠失血性休克的动物模型,两组用相应液体进行复苏,复苏成功后腹腔注入内毒素,Sham组注入0.9%氯化钠溶液.分别在注射内毒素和0.9%氯化钠溶液后24 h和48 h采集血液和肺组织标本,测定大鼠肺组织内细胞间黏附分子-1(ICAM-1)mRNA表达水平、肺髓过氧化物酶(MPO)活性、肺组织的湿重/干重(W/D)和循环内皮细胞(CEC)数量.结果 HTH组大鼠腹腔注射内毒素后24 h肺组织ICAM-1 mRNA表达水平、MPO活性、W/D、CEC计数[分别为(37.8±2.5)、(4.15±0.93)U/g、(4.59±0.18)、(9.1±2.7)/0.9 μl]与RLH组[(46.9±4.1)、(6.04±1.50)U/g、(5.25±0.23)、(11.8±3.2)/0.9 μl]比较,差异均有统计学意义(P＜0.01);HTH组大鼠腹腔注射内毒素后48 h上述指标[(45.6±6.7)、(4.62±0.78)U/g、(4.84±0.16)、(13.4±3.5)/0.9 μl]与RLH组[(54.5±6.2)、(7.59±0.88)U/g、(5.31±0.22)、(16.8±4.2)/0.9 μl]比较,差异亦有统计学意义(P＜0.01).HTH组24 h和48 h时肺损伤程度评分分别为(3.17±0.98)分和(3.19±1.20)分,RLH组24 h和48 h肺损伤程度评分分别为(4.41±1.13)分和(4.63±1.48)分,相应时间点的评分比较差异有统计学意义(t值分别为2.3448和2.2731,P＜0.05).结论采用高张溶液加6%羟乙基淀粉溶液复苏可抑制 "失血性休克-内毒素"二次打击时ICAM-1mRNA在肺内的表达、中性粒细胞在肺内的浸润和聚集以及相关炎症反应,并因此减轻肺和血管内皮细胞的损伤程度.
목적 탐토고장용액복소대"실혈성휴극-내독소"이차타격소치폐화혈관내피세포손상적영향.방법 장62지SD대서수궤분위가실혈성휴극조(Sham조)、유산납림격씨액/6%간을기정분액복소조(RLH조)화7.5%록화납용액/6%간을기정분용액복소조(HTH조).RLH화HTH조복제대서실혈성휴극적동물모형,량조용상응액체진행복소,복소성공후복강주입내독소,Sham조주입0.9%록화납용액.분별재주사내독소화0.9%록화납용액후24 h화48 h채집혈액화폐조직표본,측정대서폐조직내세포간점부분자-1(ICAM-1)mRNA표체수평、폐수과양화물매(MPO)활성、폐조직적습중/간중(W/D)화순배내피세포(CEC)수량.결과 HTH조대서복강주사내독소후24 h폐조직ICAM-1 mRNA표체수평、MPO활성、W/D、CEC계수[분별위(37.8±2.5)、(4.15±0.93)U/g、(4.59±0.18)、(9.1±2.7)/0.9 μl]여RLH조[(46.9±4.1)、(6.04±1.50)U/g、(5.25±0.23)、(11.8±3.2)/0.9 μl]비교,차이균유통계학의의(P＜0.01);HTH조대서복강주사내독소후48 h상술지표[(45.6±6.7)、(4.62±0.78)U/g、(4.84±0.16)、(13.4±3.5)/0.9 μl]여RLH조[(54.5±6.2)、(7.59±0.88)U/g、(5.31±0.22)、(16.8±4.2)/0.9 μl]비교,차이역유통계학의의(P＜0.01).HTH조24 h화48 h시폐손상정도평분분별위(3.17±0.98)분화(3.19±1.20)분,RLH조24 h화48 h폐손상정도평분분별위(4.41±1.13)분화(4.63±1.48)분,상응시간점적평분비교차이유통계학의의(t치분별위2.3448화2.2731,P＜0.05).결론 채용고장용액가6%간을기정분용액복소가억제 "실혈성휴극-내독소"이차타격시ICAM-1mRNA재폐내적표체、중성립세포재폐내적침윤화취집이급상관염증반응,병인차감경폐화혈관내피세포적손상정도.
Objective To explore the hypertonic solution in lung and vascular endothelial cell injury caused by secondary attack of endotoxin after hemorrhagic shock.Methods Sixty-two SD rats were randomly divided into groups sham,lactated Ringer′s solution and 6% hydroxyethyl starch solution resuscitation (RLH group),7.5% sodium chloride solution and 6% hydroxyethyl starch solution resuscitation(HTH group).Hemorrhagic shock models were reproduced in RLH and HTH groups.After resuscitation,the two groups were given endotoxin injection,and sham group given 0.9% sodium chloride solution.Blood and lung tissue specimens were collected at 24 h,48 h,respectively,after injection,to determine the expressions of lung tissue intercellular adhesion molecule -1(ICAM-1) mRNA,lung myeloperoxidase peroxidase(MPO),lung tissue wet/dry weight(W/D) and number of circulating endothelial cells(CEC).Results Intrapulmonary expression of ICAM-1 mRNA,Lung MPO activity,W/D weight ratio and CEC at 24 h were lower in HTH group (37.8±2.5,4.15±0.93 U/g,4.59±0.18,9.1±2.7/0.9 μl,respectively)than in RLH group(46.9±4.1,6.04±1.50 U/g,5.25±0.23,11.8±3.2/0.9 μl,respectively)(P<0.01),and those at hour 48 were lower in HTH group(45.6±6.7,4.62±0.78 U/g,4.84±0.16,13.4±3.5/0.9 μl) than those in RLH group(54.5±6.2,7.59±0.88 U/g,5.31±0.22,16.8±4.2/0.9 μl)(P<0.01).Conclusion Resuscitation with HTH solution can inhibit the expression of ICAM-1mRNA,neutrophil infiltration and accumulation in the lung,related inflammatory reaction during hemorrhagic shock/endotoxin secondary attack,and reduce injury of lung and vascular endothelial cells.