中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
1期
54-58
,共5页
复方高渗盐溶液%脓毒症%盲肠结扎穿孔术%免疫功能%髓过氧化物酶%降钙素原
複方高滲鹽溶液%膿毒癥%盲腸結扎穿孔術%免疫功能%髓過氧化物酶%降鈣素原
복방고삼염용액%농독증%맹장결찰천공술%면역공능%수과양화물매%강개소원
Compound hypertonic saline solution%Sepsis%Cecal ligation and puncture%Immunological function%Myeloperoxidase%Procalcitonin
目的 探讨复方高渗盐溶液(HSD)对脓毒症的治疗作用.方法 雄性Wistar大鼠133只,按随机数字表法分为假手术组(n=15)、盲肠结扎穿孔术(CLP)组(n=45)、CLP+生理盐水(NS)组(n=45)、CLP+HSD组(n=28)4组.采用CLP方法制备脓毒症大鼠模型,假手术组除不结扎和穿刺盲肠外,其余手术步骤相同.4组大鼠术毕均皮下注射0.9％氯化钠30 mL/kg;CLP+NS组、CLP+HSD组分别于术后3h自颈静脉内输注0.9％氯化钠或7.5％氯化钠/6％右旋糖酐70 5 mL/kg (0.4 mL·kg-1·min-1).各组于术后9h、18h观察大鼠生存率.术后0、9、18h监测平均动脉压(MAP),采用酶联免疫吸附试验(EALIS)检测血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、降钙素原(PCT)的含量.术后18h处死大鼠,检测支气管肺泡灌洗液(BALF)中性粒细胞比例、肺组织髓过氧化物酶(MPO)活性,计算肺组织湿/干质量(W/D)比值,并观察肺组织病理学改变.结果 假手术组动物未发生死亡,CLP组9h、18h生存率分别为62.2％、31.1％,CLP+NS组分别为57.8％、35.6％,CLP+HSD组分别为85.7％、64.3％;CLP+HSD组生存率较CLP组及CLP+NS组明显改善(P＜0.05或P＜0.01).与假手术组比较,CLP组及CLP+NS组术后MAP明显下降,血浆TNF-α、IL-1β、PCT水平明显升高;而CLP组与CLP+NS组比较无差异.CLP+HSD组术后9h、18h时MAP、血浆TNF-α、IL-1β、PCT水平较CLP+NS组明显改善[MAP (mmHg,1 mmHg=0.133 kPa)9 h:102±5比94±6,18h:90±2比72±3;TNF-α (ng/L) 9h:284.19±57.18比329.67±45.79,18 h:263.46±42.58比349.68±52.40; IL-1β (ng/L)9 h:219.28±39.21比263.47±32.36,18 h:195.98±39.06比250.10±41.57; PCT(μg/L)9h:2.32±0.37比4.52±0.75,18h:2.89±0.62比5.02±0.84;P＜ 0.05或P＜0.01].术后18h,CLP组及CLP+NS组BALF中性粒细胞比例、肺组织MPO活性及肺W/D比值均较假手术组显著升高,但CLP+HSD组各指标均较CLP组及CLP+NS组明显降低[中性粒细胞比例:0.094±0.019比0.148±0.062、0.151±0.055,MPO (U/g):1.19±0.45比2.31±0.79、2.64±0.69,肺W/D比值:4.02±0.63比5.14±0.59、5.12±0.83,均P＜0.05].光镜下观察,假手术组肺组织未见病理改变;CLP组及CLP+NS组可见淤血、水肿,浸润性炎性改变;而CLP+HSD组肺组织炎性改变明显减轻.结论 HSD可明显改善脓毒症大鼠循环衰竭,调节免疫紊乱,减轻急性肺损伤,并提高脓毒症大鼠生存率,推测其治疗作用是多方面的.
目的 探討複方高滲鹽溶液(HSD)對膿毒癥的治療作用.方法 雄性Wistar大鼠133隻,按隨機數字錶法分為假手術組(n=15)、盲腸結扎穿孔術(CLP)組(n=45)、CLP+生理鹽水(NS)組(n=45)、CLP+HSD組(n=28)4組.採用CLP方法製備膿毒癥大鼠模型,假手術組除不結扎和穿刺盲腸外,其餘手術步驟相同.4組大鼠術畢均皮下註射0.9％氯化鈉30 mL/kg;CLP+NS組、CLP+HSD組分彆于術後3h自頸靜脈內輸註0.9％氯化鈉或7.5％氯化鈉/6％右鏇糖酐70 5 mL/kg (0.4 mL·kg-1·min-1).各組于術後9h、18h觀察大鼠生存率.術後0、9、18h鑑測平均動脈壓(MAP),採用酶聯免疫吸附試驗(EALIS)檢測血漿腫瘤壞死因子-α(TNF-α)、白細胞介素-1β(IL-1β)、降鈣素原(PCT)的含量.術後18h處死大鼠,檢測支氣管肺泡灌洗液(BALF)中性粒細胞比例、肺組織髓過氧化物酶(MPO)活性,計算肺組織濕/榦質量(W/D)比值,併觀察肺組織病理學改變.結果 假手術組動物未髮生死亡,CLP組9h、18h生存率分彆為62.2％、31.1％,CLP+NS組分彆為57.8％、35.6％,CLP+HSD組分彆為85.7％、64.3％;CLP+HSD組生存率較CLP組及CLP+NS組明顯改善(P＜0.05或P＜0.01).與假手術組比較,CLP組及CLP+NS組術後MAP明顯下降,血漿TNF-α、IL-1β、PCT水平明顯升高;而CLP組與CLP+NS組比較無差異.CLP+HSD組術後9h、18h時MAP、血漿TNF-α、IL-1β、PCT水平較CLP+NS組明顯改善[MAP (mmHg,1 mmHg=0.133 kPa)9 h:102±5比94±6,18h:90±2比72±3;TNF-α (ng/L) 9h:284.19±57.18比329.67±45.79,18 h:263.46±42.58比349.68±52.40; IL-1β (ng/L)9 h:219.28±39.21比263.47±32.36,18 h:195.98±39.06比250.10±41.57; PCT(μg/L)9h:2.32±0.37比4.52±0.75,18h:2.89±0.62比5.02±0.84;P＜ 0.05或P＜0.01].術後18h,CLP組及CLP+NS組BALF中性粒細胞比例、肺組織MPO活性及肺W/D比值均較假手術組顯著升高,但CLP+HSD組各指標均較CLP組及CLP+NS組明顯降低[中性粒細胞比例:0.094±0.019比0.148±0.062、0.151±0.055,MPO (U/g):1.19±0.45比2.31±0.79、2.64±0.69,肺W/D比值:4.02±0.63比5.14±0.59、5.12±0.83,均P＜0.05].光鏡下觀察,假手術組肺組織未見病理改變;CLP組及CLP+NS組可見淤血、水腫,浸潤性炎性改變;而CLP+HSD組肺組織炎性改變明顯減輕.結論 HSD可明顯改善膿毒癥大鼠循環衰竭,調節免疫紊亂,減輕急性肺損傷,併提高膿毒癥大鼠生存率,推測其治療作用是多方麵的.
목적 탐토복방고삼염용액(HSD)대농독증적치료작용.방법 웅성Wistar대서133지,안수궤수자표법분위가수술조(n=15)、맹장결찰천공술(CLP)조(n=45)、CLP+생리염수(NS)조(n=45)、CLP+HSD조(n=28)4조.채용CLP방법제비농독증대서모형,가수술조제불결찰화천자맹장외,기여수술보취상동.4조대서술필균피하주사0.9％록화납30 mL/kg;CLP+NS조、CLP+HSD조분별우술후3h자경정맥내수주0.9％록화납혹7.5％록화납/6％우선당항70 5 mL/kg (0.4 mL·kg-1·min-1).각조우술후9h、18h관찰대서생존솔.술후0、9、18h감측평균동맥압(MAP),채용매련면역흡부시험(EALIS)검측혈장종류배사인자-α(TNF-α)、백세포개소-1β(IL-1β)、강개소원(PCT)적함량.술후18h처사대서,검측지기관폐포관세액(BALF)중성립세포비례、폐조직수과양화물매(MPO)활성,계산폐조직습/간질량(W/D)비치,병관찰폐조직병이학개변.결과 가수술조동물미발생사망,CLP조9h、18h생존솔분별위62.2％、31.1％,CLP+NS조분별위57.8％、35.6％,CLP+HSD조분별위85.7％、64.3％;CLP+HSD조생존솔교CLP조급CLP+NS조명현개선(P＜0.05혹P＜0.01).여가수술조비교,CLP조급CLP+NS조술후MAP명현하강,혈장TNF-α、IL-1β、PCT수평명현승고;이CLP조여CLP+NS조비교무차이.CLP+HSD조술후9h、18h시MAP、혈장TNF-α、IL-1β、PCT수평교CLP+NS조명현개선[MAP (mmHg,1 mmHg=0.133 kPa)9 h:102±5비94±6,18h:90±2비72±3;TNF-α (ng/L) 9h:284.19±57.18비329.67±45.79,18 h:263.46±42.58비349.68±52.40; IL-1β (ng/L)9 h:219.28±39.21비263.47±32.36,18 h:195.98±39.06비250.10±41.57; PCT(μg/L)9h:2.32±0.37비4.52±0.75,18h:2.89±0.62비5.02±0.84;P＜ 0.05혹P＜0.01].술후18h,CLP조급CLP+NS조BALF중성립세포비례、폐조직MPO활성급폐W/D비치균교가수술조현저승고,단CLP+HSD조각지표균교CLP조급CLP+NS조명현강저[중성립세포비례:0.094±0.019비0.148±0.062、0.151±0.055,MPO (U/g):1.19±0.45비2.31±0.79、2.64±0.69,폐W/D비치:4.02±0.63비5.14±0.59、5.12±0.83,균P＜0.05].광경하관찰,가수술조폐조직미견병리개변;CLP조급CLP+NS조가견어혈、수종,침윤성염성개변;이CLP+HSD조폐조직염성개변명현감경.결론 HSD가명현개선농독증대서순배쇠갈,조절면역문란,감경급성폐손상,병제고농독증대서생존솔,추측기치료작용시다방면적.
Objective To study the effect of compound hypertonic saline solution (HSD) on sepsis.Methods 133 male Wistar rats were divided into four groups,sham operation group (n =15),cecal ligation and puncture (CLP)group (n =45),CLP plus normal saline (NS) group (n =45),and CLP plus HSD group (n =28).A rat model of sepsis was reproduced by CLP,and the rats in sham operation group received celiotomy without ligation and puncture.All rats in four groups received subcutaneous injection of 30 mL/kg 0.9％ sodium chloride after laparotomy.The rats in CLP plus NS group and CLP plus HSD group received infusion of 5 mL/kg 0.9％ sodium chloride or 7.5％ sodium chloride/6％ dextran post CLP via jugular vein for 3 hours,with the infusion rate of 0.4 mL·kg-1·min-1.The survival rate of each group was observed 9 hours and 18 hours after laparotomy.Mean arterial pressure (MAP) at 0,9,18 hours were monitored.Blood specimens were collected from all rats 0,9 and 18 hours after laparotomy,respectively,for measurement of the plasma levels of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1β),and procalcitonin (PCT).The rats were all sacrificed,and their lung tissues were harvested for the neutrophil count in bronchoalveolar lavage fluid (BALF),myeloperoxidase (MPO) activity in lung tissue,wet/dry weight ratio (W/D) of lung,and pathological changes in lung tissue.Results There was no death in the sham operation group.The survival rates at 9 hours and 18 hours were 62.2％ and 31.1％ in the CLP group,57.8％ and 35.6％ in the CLP plus NS group,85.7％ and 64.3％ in the CLP plus HSD group,and they were all significantly higher compared with those of the CLP group and the CLP plus NS group (P ＜ 0.05 or P ＜ 0.01).MAP levels in the CLP group and the CLP plus NS group were significantly lower than those in sham operation group,and the plasma levels of TNF-α,IL-1β and PCT were significantly higher compared with those of sham operation group,while there was no difference between CLP group and the CLP plus NS group.MAP and the plasma levels of TNF-α,IL-1β and PCT in the CLP plus HSD group were significantly improved compared with those of the CLP plus NS group at 9 hours and 18 hours [MAP (mmHg,1 mmHg =0.133 kPa) at 9 hours:102±5 vs.94±6,18 hours:90±2 vs.72±3; TNF-α (ng/L) at 9 hours:284.19±57.18 vs.329.67±45.79,18 hours:263.46±42.58 vs.349.68±52.40; IL-1β (ng/L) at 9 hours:219.28±39.21 vs.263.47±32.36,18 hours:195.98±39.06 vs.250.10±41.57; PCT (μg/L) at 9 hours:2.32±0.37 vs.4.52±0.75,18 hours:2.89±0.62 vs.5.02±0.84; P ＜ 0.05 or P ＜ 0.01].The ratio of neutrophils in BALF,MPO activity and lung W/D at 18 hours in the CLP group and the CLP plus NS group were significantly higher than those of the sham operation group,while they were all significantly lower in the CLP plus HSD group than those of the CLP group and the CLP plus NS group [ratio of neutrophils in BALF:0.094±0.019 vs.0.148±0.062,0.151 ±0.055; MPO (U/g):1.19±0.45 vs.2.31 ±0.79,2.64±0.69; lung W/D ratio:4.02 ± 0.63 vs.5.14 ± 0.59,5.12 ± 0.83,all P ＜ 0.05].Under light microscope,no pathobiological changes were found in sham operation group.The lung tissues in the CLP group and the CLP plus NS group showed congestion,edema,infiltrating inflammatory changes,while the inflammatory changes in the lung tissue in the CLP plus HSD group were significantly alleviated.Conclusion HSD can obviously ameliorate the circulatory failure in septic rats,alleviate immune disturbance and acute lung injury,and improve the survival rate of rats with sepsis.
