阻断肠淋巴液回流提升失血性休克大鼠的血管反应性和钙敏感性

目的:观察肠淋巴管结扎或肠淋巴液引流对失血性休克(HS)大鼠血管反应性与钙敏感性的影响,探讨肠淋巴液在休克血管低反应性中的作用。方法:72只Wistar雄性大鼠随机均分为sham组(仅手术)、shock组(复制HS模型)、shock+ligation组(复制HS模型,行肠淋巴管结扎)、shock+drainage组(复制HS模型,行肠淋巴液引流)。记录所有动物在不同时点给予去甲肾上腺素(NE 3μg/kg)后平均动脉血压(MAP)的变化;维持低血压40 mmHg 3 h后,制备肠系膜上动脉(SMA)血管环(均n=36)。采用离体血管环张力测定技术,观察SMA血管环对NE反应性以及钙敏感性梯度Ca2+、与血管紧张素Ⅱ(AngⅡ)、胰岛素(Ins)分别孵育]的变化。结果:Shock组在休克即刻和0.5 h△MAP显著高于sham组,在1.5 h、2 h、2.5 h、3 h均显著降低;shock+ligation和shock+drainage组在休克即刻、0.5 h、1 h时△MAP显著高于sham组,在2.5 h和3 h时显著降低;shock+ligation和shock+drainage组在休克0.5 h后多个时点的△MAP均显著高于shock组。Shock、shock+ligation和shock+drainage组SMA血管环对NE的反应性和Ca2+的敏感性均显著低于sham组;shock+ligation和shock+drainage组SMA血管环对NE的反应性和Ca2+的敏感性均高于shock组。SMA与AngⅡ或Ins孵育后,shock、shock+ligation和shock+drainage组血管反应性和钙敏性均显著低于sham组,且shock+ligation和shock+drainage组均显著高于shock组。结论:以肠淋巴管结扎或肠淋巴液引流阻断休克肠淋巴液回流,均可提高HS大鼠的血管反应性,其机制与提高钙敏感性有关。

Blockage of mesenteric lymph return promotes the vascular reactivity and calcium sensitivity in hemorrhagic shock rats

AIM: To observe the effects of mesenteric lymph duct ligation and mesenteric lymph drainage on the vascular reactivity and calcium sensitivity in hemorrhagic shock (HS) rats, and to investigate the role of mesenteric lymph on the vascular hyporeactivity during shock. METHODS: Seventy-two male Wistar rats were randomly divided into sham group (only operation), shock (duplicating HS model) group, shock+ligation group (duplicating HS model and mesenteric lymph duct ligation) and shock+drainage group (duplicating HS model and mesenteric lymph drainage). The changes of mean artery pressure (MAP) after injection of norepinephrine (NE, 3 μg/kg) at different time points were recorded. After hypotension (40 mmHg) for 3 h, the vascular ring of superior mesenteric artery (SMA) was made for determining the vascular reactivity and sensitivity to calcium by observing the contraction initiated by NE and Ca²⁺ under depolarizing conditions (120 mmol/L K⁺) in the isolated organ perfusion system. Meanwhile, the effects of angiotensin Ⅱ (AngⅡ) and insulin (Ins) on the vascular reactivity were also observed. RESULTS: Compared to sham group, the △MAP in shock group was increased significantly at 0 h and 0.5 h after shock, and that was decreased markedly at 1.5 h, 2 h, 2.5 h and 3 h after shock, respectively, and that in shock+ligation group and shock+drainage group was increased at 0 h, 0.5 h and 1 h after shock, decreased at 2.5 h and 3 h after shock, respectively. The △MAP in shock+ligation group and shock+drainage group was higher than that in shock group at 0.5 h after shock and all the time points followed. The SMA reactivity to NE and sensibility to Ca²⁺ in shock group, shock+ligation group and shock+drainage group were lower markedly than those in sham group. The vascular reactivity and calcium sensitivity in shock+ligation and shock+drainage groups were higher than those in shock group. The vascular reactivity and calcium sensitivity in shock group, shock+ligation group and shock+drainage group were lower than those in sham group, and those in shock+ligation and shock+drainage groups were increased as compared to shock group, respectively. CONCLUSION: Blockage of mesenteric lymphatic return with the methods of mesenteric lymph duct ligation and mesenteric lymph drainage promotes the vascular reactivity of HS rats. The mechanism may be related to improving the calcium sensitivity in the vasculature.