限制性液体复苏对孕兔肺缺血再灌注损伤的保护作用

目的 应用孕兔非控制性失血性休克模型研究不同液体复苏方案对孕兔失血性休克时肺脏超氧化物歧化酶(SOD)、丙二醛(MDA)、髓过氧化物酶(MPO)水平的影响,探讨不同液体复苏方法对孕兔肺缺血再灌注损伤的保护作用.方法 30只孕中晚期新西兰大白兔被随机分为5组,建立重度控制性失血性休克模型,假休克组(SS组),休克未处理组(SH组),传统复苏组(NS组)、限制性复苏组(NH组)及高渗高胶限制性复苏组(HHH组)分别于休克30min后接受不同的液体复苏方案.各组均于休克后90 min接受手术止血和输血输液治疗.于实验结束后处死动物取肺脏检测SOD、MDA和MPO水平.结果 失血性休克时缺血再灌注损伤导致肺组织SOD活性降低及MDA、MPO水平增高,其中MDA、MPO水平HHH组、NH组显著低于NS组(P<0.05),HHH组显著低于NH组(P<0.05);SOD活性呈与MDA相反的变化趋势.结论 限制性输液复苏较传统快速输液复苏缓解了组织缺血再灌注后肺损伤,羟乙基淀粉高渗盐可显著抑制肺组织再灌注损伤.

Protective effect of hypotensive fluid resuscitation against lung ischemia-reperfusion injury in pregnant rabbits with uncontrolled hemorrhagic shock

OBJECTIVE: To evaluate the effects of different fluid resuscitation strategies on superoxide dismutase (SOD), malondialdehyde (MDA) and myeloperoxidase (MPO) activities in the lung tissue in pregnant rabbits with uncontrolled hemorrhagic shock. METHODS: Thirty pregnant New Zealand rabbits were randomized into 5 equal groups, namely the sham shock.(SS) group, shock group without interventions (SH group), and hemorrhagic shock groups with conventional normal saline (NS) resuscitation, NS hypotensive resuscitation, and hypertonic hyperosmotic hypotensive resuscitation (NS, NH, HHH groups, respectively) 30 min after the shock. At the end of the experiment, the rabbits were sacrificed, and the lungs were taken for detection of MDA, MPO and SOD levels. RESULTS: Ischemia-reperfusion injury of the lungs in uncontrolled hemorrhagic shock resulted in decreased SOD and increased MDA and MPO contents. The MDA and MPO contents in HHH group were significantly lower than those in NH group, and both the groups, MDA and MPO contents were significantly lower than those of NS group (P<0.05). SOD activity was significantly higher in HHH group than in NH group (P<0.05). CONCLUSION: In pregnant rabbits with uncontrolled hemorrhagic shock, hypotensive resuscitation more effectively ameliorates ischemia-reperfusion injuries in the lungs than aggressive fluid resuscitation, and hyperosmotic crystalloid and hyperonoctic colloid resuscitation provide significant protective effects against such injuries.