高张溶液复苏对“失血性休克-内毒素”二次打击所致肺和血管内皮细胞损伤的影响

目的 探讨高张溶液复苏对"失血性休克-内毒素"二次打击所致肺和血管内皮细胞损伤的影响.方法 将62只SD大鼠随机分为假失血性休克组(Sham组)、乳酸钠林格氏液/6%羟乙基淀粉液复苏组(RLH组)和7.5%氯化钠溶液/6%羟乙基淀粉溶液复苏组(HTH组).RLH和HTH组复制大鼠失血性休克的动物模型,两组用相应液体进行复苏,复苏成功后腹腔注入内毒素,Sham组注入0.9%氯化钠溶液.分别在注射内毒素和0.9%氯化钠溶液后24 h和48 h采集血液和肺组织标本,测定大鼠肺组织内细胞间黏附分子-1(ICAM-1)mRNA表达水平、肺髓过氧化物酶(MPO)活性、肺组织的湿重/干重(W/D)和循环内皮细胞(CEC)数量.结果 HTH组大鼠腹腔注射内毒素后24 h肺组织ICAM-1 mRNA表达水平、MPO活性、W/D、CEC计数分别为(37.8±2.5)、(4.15±0.93)U/g、(4.59±0.18)、(9.1±2.7)/0.9 μl]与RLH组(46.9±4.1)、(6.04±1.50)U/g、(5.25±0.23)、(11.8±3.2)/0.9 μl]比较,差异均有统计学意义(P＜0.01);HTH组大鼠腹腔注射内毒素后48 h上述指标(45.6±6.7)、(4.62±0.78)U/g、(4.84±0.16)、(13.4±3.5)/0.9 μl]与RLH组(54.5±6.2)、(7.59±0.88)U/g、(5.31±0.22)、(16.8±4.2)/0.9 μl]比较,差异亦有统计学意义(P＜0.01).HTH组24 h和48 h时肺损伤程度评分分别为(3.17±0.98)分和(3.19±1.20)分,RLH组24 h和48 h肺损伤程度评分分别为(4.41±1.13)分和(4.63±1.48)分,相应时间点的评分比较差异有统计学意义(t值分别为2.3448和2.2731,P＜0.05).结论 采用高张溶液加6%羟乙基淀粉溶液复苏可抑制 "失血性休克-内毒素"二次打击时ICAM-1mRNA在肺内的表达、中性粒细胞在肺内的浸润和聚集以及相关炎症反应,并因此减轻肺和血管内皮细胞的损伤程度.

Influence of Hypertonic Solution on Lung and Vascular Endothelial Cell Injury Caused by Secondary Attack of Endotoxin after Hemorrhagic Shock

Objective To explore the hypertonic solution in lung and vascular endothelial cell injury caused by secondary attack of endotoxin after hemorrhagic shock.Methods Sixty-two SD rats were randomly divided into groups sham,lactated Ringer′s solution and 6% hydroxyethyl starch solution resuscitation (RLH group),7.5% sodium chloride solution and 6% hydroxyethyl starch solution resuscitation(HTH group).Hemorrhagic shock models were reproduced in RLH and HTH groups.After resuscitation,the two groups were given endotoxin injection,and sham group given 0.9% sodium chloride solution.Blood and lung tissue specimens were collected at 24 h,48 h,respectively,after injection,to determine the expressions of lung tissue intercellular adhesion molecule -1(ICAM-1) mRNA,lung myeloperoxidase peroxidase(MPO),lung tissue wet/dry weight(W/D) and number of circulating endothelial cells(CEC).Results Intrapulmonary expression of ICAM-1 mRNA,Lung MPO activity,W/D weight ratio and CEC at 24 h were lower in HTH group (37.8±2.5,4.15±0.93 U/g,4.59±0.18,9.1±2.7/0.9 μl,respectively)than in RLH group(46.9±4.1,6.04±1.50 U/g,5.25±0.23,11.8±3.2/0.9 μl,respectively)(P<0.01),and those at hour 48 were lower in HTH group(45.6±6.7,4.62±0.78 U/g,4.84±0.16,13.4±3.5/0.9 μl) than those in RLH group(54.5±6.2,7.59±0.88 U/g,5.31±0.22,16.8±4.2/0.9 μl)(P<0.01).Conclusion Resuscitation with HTH solution can inhibit the expression of ICAM-1mRNA,neutrophil infiltration and accumulation in the lung,related inflammatory reaction during hemorrhagic shock/endotoxin secondary attack,and reduce injury of lung and vascular endothelial cells.