中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2009年
6期
614-617
,共4页
失血性休克%液体复苏,限制性%缺血-再灌注损伤%肝脏
失血性休剋%液體複囌,限製性%缺血-再灌註損傷%肝髒
실혈성휴극%액체복소,한제성%결혈-재관주손상%간장
Hemorrhagic shock%Limited resuscitation%Ischemia-reperfusion injury%Liver
目的 探讨限制性液体复苏对失血性休克大鼠肝脏缺血-再灌注损伤的影响.方法 54只Wistar大鼠应用Krausz等人工制作的标准脾脏损伤+切断脾中部一动脉分支制作重度未控制出血性休克模型,当平均动脉压(MAP)降至40 mmHg时开始应用平衡盐液复苏,依据维持MAP的不同随机分为40,50,60,80和100 mmHg组(分别记为RS40,RS50,RS60,RS80,RS100组)和假手术组(SS组).脾损伤前记为TO时点.在45 min时(T45时点)结扎止血,再应用平衡盐液+全血(2:1)复苏,使MAP尽量维持在100 mmHg,2 h后(T165时点)停止输液,观察4 h(T405时点).于TO,T45,T165和T405时点抽血测定血乳酸;于T405时点取部分肝组织测定组织血流量、ATP酶、丙二醛(MDA)和总抗氧化能力(TAOC).统计学采用单因素方差分析(SNK-q检验).结果 随着维持MAP的提高,肝组织ATP酶、TAOC和肝组织血流量逐渐降低,而MDA和血乳酸却逐渐增高.在T405时点:血乳酸在RS80和RS100组[(3.60 ±0.68)mmol/L,(3.84±1.09)mmol/L]均明显高于SS,RS40,RS50和RS60组[(2.00±0.66)mmol/L,(2.74±1.45)mmol/L,(2.43±0.94)mmol/L,(2.07±0.95)mmol/L](P<0.05);MDA在RS80和RS100组[(7.32±0.31)mmol/mg,(7.71±0.23)nmol/mg]均明显高于SS,RS40,RS50和RS60组[(4.95±0.80)nmol/mg,(6.14±0.94)nmol/mg,(6.42±0.48)mnol/mg,(6.84±0.36)nmol/mg](P<0.05);肝组织ATP酶活性和TAOC在RS各组均明显低于SS组(P<0.05),而在RS80和RS100组则明显低于RS40,RS50和RS60组(P<0.05);肝组织血流量在RS80和RS100组均明显低于其他4组(P<0.05).结论 在出血未控制条件下,限制性液体复苏明显提高肝组织的血液灌注、改善微循环、减轻酸中毒和肝组织的脂质过氧化损伤,减轻了肝脏缺血-再灌注损伤.
目的 探討限製性液體複囌對失血性休剋大鼠肝髒缺血-再灌註損傷的影響.方法 54隻Wistar大鼠應用Krausz等人工製作的標準脾髒損傷+切斷脾中部一動脈分支製作重度未控製齣血性休剋模型,噹平均動脈壓(MAP)降至40 mmHg時開始應用平衡鹽液複囌,依據維持MAP的不同隨機分為40,50,60,80和100 mmHg組(分彆記為RS40,RS50,RS60,RS80,RS100組)和假手術組(SS組).脾損傷前記為TO時點.在45 min時(T45時點)結扎止血,再應用平衡鹽液+全血(2:1)複囌,使MAP儘量維持在100 mmHg,2 h後(T165時點)停止輸液,觀察4 h(T405時點).于TO,T45,T165和T405時點抽血測定血乳痠;于T405時點取部分肝組織測定組織血流量、ATP酶、丙二醛(MDA)和總抗氧化能力(TAOC).統計學採用單因素方差分析(SNK-q檢驗).結果 隨著維持MAP的提高,肝組織ATP酶、TAOC和肝組織血流量逐漸降低,而MDA和血乳痠卻逐漸增高.在T405時點:血乳痠在RS80和RS100組[(3.60 ±0.68)mmol/L,(3.84±1.09)mmol/L]均明顯高于SS,RS40,RS50和RS60組[(2.00±0.66)mmol/L,(2.74±1.45)mmol/L,(2.43±0.94)mmol/L,(2.07±0.95)mmol/L](P<0.05);MDA在RS80和RS100組[(7.32±0.31)mmol/mg,(7.71±0.23)nmol/mg]均明顯高于SS,RS40,RS50和RS60組[(4.95±0.80)nmol/mg,(6.14±0.94)nmol/mg,(6.42±0.48)mnol/mg,(6.84±0.36)nmol/mg](P<0.05);肝組織ATP酶活性和TAOC在RS各組均明顯低于SS組(P<0.05),而在RS80和RS100組則明顯低于RS40,RS50和RS60組(P<0.05);肝組織血流量在RS80和RS100組均明顯低于其他4組(P<0.05).結論 在齣血未控製條件下,限製性液體複囌明顯提高肝組織的血液灌註、改善微循環、減輕痠中毒和肝組織的脂質過氧化損傷,減輕瞭肝髒缺血-再灌註損傷.
목적 탐토한제성액체복소대실혈성휴극대서간장결혈-재관주손상적영향.방법 54지Wistar대서응용Krausz등인공제작적표준비장손상+절단비중부일동맥분지제작중도미공제출혈성휴극모형,당평균동맥압(MAP)강지40 mmHg시개시응용평형염액복소,의거유지MAP적불동수궤분위40,50,60,80화100 mmHg조(분별기위RS40,RS50,RS60,RS80,RS100조)화가수술조(SS조).비손상전기위TO시점.재45 min시(T45시점)결찰지혈,재응용평형염액+전혈(2:1)복소,사MAP진량유지재100 mmHg,2 h후(T165시점)정지수액,관찰4 h(T405시점).우TO,T45,T165화T405시점추혈측정혈유산;우T405시점취부분간조직측정조직혈류량、ATP매、병이철(MDA)화총항양화능력(TAOC).통계학채용단인소방차분석(SNK-q검험).결과 수착유지MAP적제고,간조직ATP매、TAOC화간조직혈류량축점강저,이MDA화혈유산각축점증고.재T405시점:혈유산재RS80화RS100조[(3.60 ±0.68)mmol/L,(3.84±1.09)mmol/L]균명현고우SS,RS40,RS50화RS60조[(2.00±0.66)mmol/L,(2.74±1.45)mmol/L,(2.43±0.94)mmol/L,(2.07±0.95)mmol/L](P<0.05);MDA재RS80화RS100조[(7.32±0.31)mmol/mg,(7.71±0.23)nmol/mg]균명현고우SS,RS40,RS50화RS60조[(4.95±0.80)nmol/mg,(6.14±0.94)nmol/mg,(6.42±0.48)mnol/mg,(6.84±0.36)nmol/mg](P<0.05);간조직ATP매활성화TAOC재RS각조균명현저우SS조(P<0.05),이재RS80화RS100조칙명현저우RS40,RS50화RS60조(P<0.05);간조직혈류량재RS80화RS100조균명현저우기타4조(P<0.05).결론 재출혈미공제조건하,한제성액체복소명현제고간조직적혈액관주、개선미순배、감경산중독화간조직적지질과양화손상,감경료간장결혈-재관주손상.
Objective To investigate the effects of limited resuscitation on hepatic ischernia-reperfusion in-jury in rots with hemorrhagic shock. Method Uncontrolled hemorrhagic shock was induced in 54 rats by transect-ing the middle branch of the splenic artery to produce standardized massive splenic injury. Resuscitation started when the mean arterial pressure (MAP) reached 40 mmHg. The rats were randomly divided (n = 9per group) in-to sham-operated group (SS), or one of five treatment groups in which infusion of Ringer' s solution was continually administrated to maintain MAP at 40 (RS40), 50 (RS50), 60 (RS60), 80 (RS80) or 100 mmHg (RS100) for 45 minutes (T45 point). After the bleeding was controlled, resuscitation was continued with Ringer's solution and whole blood (2:1) to increase the MAP to 100 mmHg for 120 minutes (T165 point), which was followed by obser-vation for 240 minutes (T405 point). All animals were observed for 240 minutes or until death. Blood specimens were collected at TO, T45, T165 and T405 for determination of blood lactate levels. At the end of the experiment,a small amount of hepatic tissue was collected to measure tissue blood perfusion, total antioxidative capacity (TAOC), Na+K+ ATPase activity and malondialdehyde (MDA) levels. Results At T405, the blood lactate lev-els in the RS80 and RS100 groups [(3.60±0.68) and (3.84 ± 1.09) mmol/L, respectively] were significantly higher than those in the SS, RS40, RS50 and RS60 groups [(2.00±0.66),(2.74±1.45),(2.43 +0.94) and (2.07±0.95) mmol/L, respectively;all:P < 0.05]. The MDA levels were significantly higher in the RS80 and RS100[(7.32±0.31) and (7.71±0.23) nmol/mg,respectively] than those in the SS, RS40, RS50 and RS60 groups[(4.95±0.80),(6.14±0.94),(6.42±0.48) and (6.84±0.36) nmol/mg, respeetively;all: P <0.05]. The Na+ K+ ATPase and TAOC levels were significantly lower in all of the RS groups than those in the SS group (all: P < 0.05), and those in the RS80 and RS100 groups was significantly lower than those in the RS40,RS50 and RS60 groups (all: P <0.05). Blood perfusion in the RS80 and RS100 groups was significantly lower than that in the other groups (all: P < 0.05). Conclusions If hemorrhage is uncontrolled, limited resuscitation appears to balance the needs for organ perfusion, improve the microcircttlation and decrease lactate levels. Fur-thermore, limited resuscitation could decrease ischemia-reperfusion injury in liver tissue.
