CAJ | 학술논문

目的探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)联合超滤技术在严重失血性休克兔肾脏损伤中的意义. 方法新西兰大白兔24只,建立压力控制型失血性休克模型,按随机数字表法分为休克未复苏组(未复苏组)、ECMO联合超滤技术复苏组(联合复苏组)、延迟液体复苏组(液体复苏组),每组8只.心电监护检测心率,股动脉置管检测动脉血压.分别于休克前、休克后及复苏后采集血液标本,检测乳酸、血肌酐、IL-6及TNF-α水平.采集各组肾脏标本行HE染色,观察各组肾脏组织病理学改变;免疫组织化学染色,比较各组热休克蛋白70(heat shock protein 70,HSP70)在肾脏组织中的表达程度. 结果联合复苏组的平均动脉压(53.1±1l.4)mmHg,较液体复苏组(41.3 ±11.1) mmHg和未复苏组(25.9±10.5) mmHg明显升高(F =41.425,P＜0.05).乳酸、血肌酐、IL-6和TNF-α的水平,各组休克后较休克前均明显升高(P＜0.05),液体复苏组较未复苏组均明显降低(P＜0.05),联合复苏组较液体复苏组均明显降低(P＜0.05).HE染色显示,联合复苏组肾脏组织坏死程度及炎症因子浸润程度均较液体复苏组明显减轻.HSP70的表达未复苏组中位数(四分位数)为17 828.960 0 (15 779.865 0～21 751.980 0),液体复苏组为2 714.270 0(1 339.215 0 ～7 616.950 0),联合复苏组为262.930 0(198.820 0～538.195 0),三组间差异有统计学意义(P＜0.05). 结论与传统液体复苏比较,ECMO联合超滤技术在复苏严重失血性休克、改善组织缺氧性损害、减轻炎性反应等方面具有优势,并且能显著减轻肾脏组织的损伤.
목적 탐토체외막폐양합(extracorporeal membrane oxygenation,ECMO)연합초려기술재엄중실혈성휴극토신장손상중적의의. 방법 신서란대백토24지,건립압력공제형실혈성휴극모형,안수궤수자표법분위휴극미복소조(미복소조)、ECMO연합초려기술복소조(연합복소조)、연지액체복소조(액체복소조),매조8지.심전감호검측심솔,고동맥치관검측동맥혈압.분별우휴극전、휴극후급복소후채집혈액표본,검측유산、혈기항、IL-6급TNF-α수평.채집각조신장표본행HE염색,관찰각조신장조직병이학개변;면역조직화학염색,비교각조열휴극단백70(heat shock protein 70,HSP70)재신장조직중적표체정도. 결과 연합복소조적평균동맥압(53.1±1l.4)mmHg,교액체복소조(41.3 ±11.1) mmHg화미복소조(25.9±10.5) mmHg명현승고(F =41.425,P＜0.05).유산、혈기항、IL-6화TNF-α적수평,각조휴극후교휴극전균명현승고(P＜0.05),액체복소조교미복소조균명현강저(P＜0.05),연합복소조교액체복소조균명현강저(P＜0.05).HE염색현시,연합복소조신장조직배사정도급염증인자침윤정도균교액체복소조명현감경.HSP70적표체미복소조중위수(사분위수)위17 828.960 0 (15 779.865 0～21 751.980 0),액체복소조위2 714.270 0(1 339.215 0 ～7 616.950 0),연합복소조위262.930 0(198.820 0～538.195 0),삼조간차이유통계학의의(P＜0.05). 결론 여전통액체복소비교,ECMO연합초려기술재복소엄중실혈성휴극、개선조직결양성손해、감경염성반응등방면구유우세,병차능현저감경신장조직적손상.
Objective To investigate the effect of extracorporeal membrane oxygenation (ECMO) combined with ultrafiltration in treatment of kidney injury induced by serious hemorrhagic shock in rabbits.Methods Models of pressure-controlled hemorrhagic shock was developed in 24 New Zealand white rabbits which were divided into unresuscitation group (n =8),ECMO combined with ultrafiltration group (combined resuscitation group,n =8),and fluid resuscitation group (n =8) according to the random number table.Heart rate was monitored via electrocardiograph and arterial pressure via fermoral artery catheter.Blood samples were collected pre-and post-shock and after resuscitation to measure levels of lactic acid,serum creatinine,IL-6,and TNF-α.Kidney samples were collected for measurement of histopathological changes via HE staining,expression of heat shock protein 70 (HSP70) via immunohistochemical staining.Results Arterial pressure was (53.1 ± 11.4) mmHg in combined resuscitation group,higher than (41.3 ± 11.1) mmHg in fluid resuscitation group and (25.9 ± 10.5) mmHg in unresuscitation group (F =41.425,P ＜ 0.05).Hemorrhagic shock induced significant up-regulation of lactic acid,serum creatinine,IL-6,and TNF-α(P ＜ 0.05),but all were lowered after resuscitation,especially in combined resuscitation group (P ＜ 0.05).HE staining showed the degree of kidney tissue necrosis and inflammatory cytokine infiltration in combined resuscitation group alleviated notably compared with fluid resuscitation group.Median and interquartile values of HSP70 were 17 828.960 0 (15 779.865 0-21 751.980 0) in unresuscitation group,2 714.270 0 (1 339.215 0-7 616.950 0) in fluid resuscitation group,and 262.930 0 (198.820 0-538.195 0) in combine resuscitation group,with statistical differences among groups(P ＜ 0.05).Conclusion ECMO combined with ultrafiltration is superior to conventional fluid resuscitation in improving hypoxia tissue injury and inflammatory reaction after hemorrhagic shock and is beneficial to attenuating kidney injury.