创伤性休克兔复苏后肾功能的变化及亚甲蓝的影响

目的研究亚甲蓝（methylene blue,MB）对创伤性休克兔肾脏的保护作用及其可能机制。方法选用健康日本长耳大白兔18只,随机分为对照组（CON组）、生理盐水复苏组（NS组）、MB处理组（MB组）,每组6只。NS组及MB组观察休克前（T1）、休克末（T2）、复苏末（T3）及复苏后2 h（T4）、4 h（T5）、6 h（T6）、8 h（T7）时间点平均动脉压（MAP）的动态变化,测定各时间点血浆尿素氮（BUN）、肌酐（Cr）水平。观察各组兔肾组织光镜下病理形态学变化。结果 NS组复苏末及复苏后各时间点MAP均未达到基础值水平（P〈0.05）;复苏末及复苏后各时间点MAP与CON组比较差异有统计学意义（P〈0.05）;复苏后2 h、6 h、8 h的MAP与MB组比较差异有统计学意义（P〈0.05）。MB组休克末及复苏后2 h MAP与基础值比较差异有统计学意义（P〈0.05）,与CON组比较差异有统计学意义（P〈0.05）。兔创伤性休克复苏后各时间点NS组、MB组BUN、Cr水平较CON组升高（P〈0.05）,但MB组BUN、Cr水平较NS组明显降低（P〈0.05）。光镜下NS组和MB组肾脏可见轻微的病理改变,但两组之间无明显差异,较对照组亦无明显改变。结论创伤性休克可致兔肾功能损害,MB能显著改善休克后兔血流动力学、肾功能,保护肾脏组织。

The changes of kidney function after resuscitation in rabbits with traumatic shock and the effects of methylene blue

Objective To study the protective effect of methylene blue（MB） on the kidneys in rabbits with traumatic shock and the potential mechanism.Methods 18 Japanese rabbits were randomized into 3 groups（n=6 each）： control group（CON group）,resuscitation with normal saline group（NS group） and methylene blue group（MB group）.In NS group and MB group,the dynamic variations of mean arterial pressure（MAP） at different time points was recorded,i.e.,before shock（T1）,at the end of shock（T2）,at the end of resuscitation（T3）,2 h（T4）,4 h（T5）,6 h（T6） and 8 h（T7） after resuscitation,and the level of blood urea nitrogen（BUN） and creatinine（Cr） in the plasma at each time points was determined.Tissue samples of the kidney obtained from experiments were observed for pathomorphological changes under the light microscope.Results In NS group,the MAP level at the end of resuscitation and at each time point after resuscitation did not reach the basal value（P〈0.05）;and the MAP level at these time points had significant statistical difference as compare to CON group（P〈0.05）;the MAP levels at T4,T6 and T7 had significant statistical difference vs.MP group（P〈0.05）.In MB group,the MAP level at T2 and T4 had statistical difference vs.the basal value（P〈0.05） and vs.CON group（P〈0.05）.In the NS and MB groups,the level of plasma BUN and Cr markedly increased,compared with that in CON group（P〈0.05）,while the level of BUN and Cr was obviously lower in MB group than that in NS group（P〈0.05）.Light microscopy revealed slight pathological changes in kidney tissues in NS and MB groups,but the differences were not significant between NS and MB groups and among the 3 groups.Conclusion The kidney function of rabbits could be vulnerable to traumatic shock.MB can notably ameliorate the hemodynamics and function of the kidney in rabbits with traumatic shock and protect the renal tissues.