CAJ | 학술논문

目的了解大鼠在沙漠干热环境中暑状态下肾损害的变化特点,为临床救治提供理论依据.方法 48只大鼠,麻醉后随机(随机数字法)分成6组:轻度沙漠干热环境中暑组及其对照组,中度沙漠干热环境中暑组及其对照组,重度沙漠干热环境中暑组及其对照组.参照沙漠干热环境大鼠中暑模型,将各干热环境中暑组持续置于沙漠干热环境(41℃,10％湿度)下,各对照组持续置于常温环境(25℃,35％湿度)下,在各组大鼠的不同中暑阶段,取肾组织、肌组织行病理学检测,取腹主动脉血行肌酸激酶(creatine kinase,CK)、肌酐(creatinine,CREAT)、尿素(urea)、尿酸(uric acid,UA)检测.结果病理学检测发现,在沙漠干热环境中暑时肾组织呈现出血管的扩张充血、血栓形成、出血、蛋白管型、内皮细胞损伤等,轻度中暑阶段以血管扩张充血为主,中度中暑阶段以血栓形成较明显,重度中暑阶段以出血及蛋白管型较明显;肌组织出现肌溶解,以重度阶段明显;各血液指标在三个中暑阶段的演变中,差异均具有统计学意义(CK:F=136.204,P=0.000; CREAT:F=172.865,P=0.000; UA:F=546.454,P=0.000; urea:F=73.823,P=0.000);尚不能认为尿酸(UA)在轻度中暑阶段与其对照组的差异具有统计学意义(t=1.943,P=0.072),其余指标各阶段中暑组与对照组的差异均具有统计学意义(P=0.000).结论沙漠干热环境中暑大鼠的肾脏损伤随着中暑过程的演变而加重,提示抢救沙漠干热环境中暑患者,应该警惕弥漫性血管内凝血(DIC)、肌溶解、急性肾衰竭的出现;同时严密监测血液生化指标并积极处理.
목적 료해대서재사막간열배경중서상태하신손해적변화특점,위림상구치제공이론의거.방법 48지대서,마취후수궤(수궤수자법)분성6조:경도사막간열배경중서조급기대조조,중도사막간열배경중서조급기대조조,중도사막간열배경중서조급기대조조.삼조사막간열배경대서중서모형,장각간열배경중서조지속치우사막간열배경(41℃,10％습도)하,각대조조지속치우상온배경(25℃,35％습도)하,재각조대서적불동중서계단,취신조직、기조직행병이학검측,취복주동맥혈행기산격매(creatine kinase,CK)、기항(creatinine,CREAT)、뇨소(urea)、뇨산(uric acid,UA)검측.결과 병이학검측발현,재사막간열배경중서시신조직정현출혈관적확장충혈、혈전형성、출혈、단백관형、내피세포손상등,경도중서계단이혈관확장충혈위주,중도중서계단이혈전형성교명현,중도중서계단이출혈급단백관형교명현;기조직출현기용해,이중도계단명현;각혈액지표재삼개중서계단적연변중,차이균구유통계학의의(CK:F=136.204,P=0.000; CREAT:F=172.865,P=0.000; UA:F=546.454,P=0.000; urea:F=73.823,P=0.000);상불능인위뇨산(UA)재경도중서계단여기대조조적차이구유통계학의의(t=1.943,P=0.072),기여지표각계단중서조여대조조적차이균구유통계학의의(P=0.000).결론 사막간열배경중서대서적신장손상수착중서과정적연변이가중,제시창구사막간열배경중서환자,응해경척미만성혈관내응혈(DIC)、기용해、급성신쇠갈적출현;동시엄밀감측혈액생화지표병적겁처리.
Objective To observe the function of kidney compromised and histopathological changes of renal tissue in heatstroke rats under the dry-heat atmosphere of desert in order to find the mechanism for provide a rationale of clinical treatment.Methods Forty-eight anaesthetized rats were divided into six groups (n =8 in each group):mild heatstroke group with its control group,moderate heatstroke group with its control group,and severe heatstroke group with its control group.The rats of three heatstroke groups were placed in a dry-heat environment prolonged with 41 ℃ and 10％ humidity,and the three control groups were placed in a room temperature prolonged with 25 ℃ and 35％ humidity.At heatstroke status of each group,arterial blood samples were collected from each group for testing creatine kinase (CK),creatinine (CREAT),uric acid (UA) and urea,kidney tissues and muscle tissues were taken for pathological examinations.Results Pathological examination showed dilatation and congestion of vessels,thrombosis,bleeding,protein casts and endothelium injury were found in the heatstroke rats.In mild heatstroke,the pathological changes mainly manifested as dilatation and congestion of vessels ; in moderate one,the changes mainly manifested as thrombosis; and in severe one,changes mainly manifested as bleeding and protein casts.Muscle tissues presented rhabdomyolysis,especially in severe one.The differences in biomarkers between three different degrees of heatstroke showed statistical significance (CK:F =136.204,P =0.000;CREAT:F =172.865,P=0.000; UA:F=546.454,P=0.000; urea:F=73.823,P=0.000).There was no significant difference in UA between mild heatstroke group and its control group (t =1.943 ;P =0.072),and the differences in rest biomarkers showed statistical significance between each heatstroke group and its control group (P =0.000).Conclusions The kidney injury developed during heatstroke in dry-heat environment of desert suggests that we should be alert to disseminated intravascular coagulation (DIC),myolysis and acute kidney failure,and should monitor the blood biochemical changes closely and treat it energetically,rescuing a heatstroke patient in dry-heat environment of desert.