内源性舒张因子在失血性休克中的变化

目的探讨内源性舒张因子一氧化氮（NO）与一氧化碳（CO）在失血性休克中的变化。方法按照Wigger’s改良法制作家猪失血性休克模型，失血性休克（H）组经股动脉快速放血使MAP降至40mmHg，然后复苏。对照（C）组处理同H组，但未失血。各组分别在休克前、休克末、复苏末、复苏后30、60、120、240min分别记录平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）、肺动脉压（PAP）、肺动脉楔压（PCWP）、气道压（Peak）的变化，采血测定pH值、BE值、CO、NO及乳酸盐（Lae）水平。结果H组休克后MAP、PAP和CVP降低而HR升高，Peak、PCWP无显著变化。血浆NO水平在休克后逐渐升高，复苏后120min显著高于休克前和c组水平，此后一直维持较高水平，240rain时达到高峰。休克后CO水平逐渐增加，复苏后120min显著高于休克前，并高于c组，此后逐渐下降；Lac在失血后显著升高，休克末达峰值，显著高于休克前和c组，以后逐渐下降。pH值、BE值在休克后逐渐下降，与c组相比有显著差异。结论失血性休克后NO、CO水平增加，可能作为两种内源性保护因子起作用。

Changes of endogenous relaxing factor in hemorrhagic shock

Objective To investigate the changes of endogenous relaxing factors(NO/ CO) and explore their possible involvements in the development of hemorrhagic shock.Methods 14 pigs were randomly divided into two groups: hemorrhagic shock group(n=7) and control group(n=7).The shock state(MAP = 40 mmHg) was induced by controlled bleeding and maintained for 90 min,then resuscitated.The control group did not undergo hemorrhage.MAP,HR,CVP,PAP,PCWP,and Peak were monitored.The concentrations of CO in pulmonary artery and NO in femoral artery were determined before sboch,after shock,immediately after resuscitation,and time points at 30,60,120,and 240 min after resuscitation.The concentrations of arterial lactate,pH,and BE were detected.Results After withdrawal of blood,MAP,PAP,and CVP decreased in group H,while HR increased and PCWP,Peak remained as that before shock,The plasma No level was markedly elevated at 60 min after resuscitation,and remained higher later.There was a tendency of CO increase at 120 min after resuscitation in group H,and then declined.The value of pH and BE were decreased after shock;The concentrations of lactate was markedly increased at the end of shock,and then declined.Conclusions Increased concentrations of endogenous NO and CO may play a protective role in the pathogenesis of hemorrhagic shock.