不同液体腹腔复苏对失血性休克大鼠肠道炎性反应的影响

目的 探讨不同液体腹腔复苏对失血性休克大鼠肠道炎性反应的影响.方法 清洁级健康雄性SD大鼠50只,体重200～250 g,随机分为5组(n=10):假手术组(S组)仅行手术操作,不制备失血性休克模型;采用股动脉置管放血法制备大鼠失血性休克模型,常规静脉复苏组(CVR组)失血性休克1 h后,经左侧股静脉匀速回输自体血及相当于2倍失血量的生理盐水行常规静脉复苏;不同液体腹腔复苏组(DPR1～3组)行常规静脉复苏,同时分别腹腔输注生理盐水、6%羟乙基淀粉130/0.4、2.5%腹膜透析液20 ml行腹腔复苏.输注时间均为30 min.右颈总动脉连接多功能监测仪持续监测平均动脉压;于复苏后2 h时股动脉采血,测定乳酸浓度,取小肠组织检测髓过氧化物酶(MPO)活性,采用免疫组化法检测小肠组织肿瘤坏死因子α(TNF-α)表达水平,光镜下观察小肠黏膜组织形态,计算小肠黏膜上皮损伤指数.结果 与S组比较,其余各组大鼠复苏后平均动脉压差异无统计学意义(P>0.05),动脉血乳酸浓度、小肠组织MPO活性、TNF-α表达水平及小肠黏膜上皮损伤指数升高(P<0.05或0.01);与CVR组比较,DPR3组动脉血乳酸浓度、小肠组织MPO活性、TNF-α表达水平及小肠黏膜上皮损伤指数降低(P<0.05).结论 采用2.5%腹膜透析液20 ml行腹腔复苏可有效抑制肠道炎性反应,从而对失血性休克大鼠产生保护作用.

Effects of direct peritoneal resuscitation with different fluids on intestinal inflammatory response in hemorrhagic shock rats

Objective To investigate the effects of direct peritoneal resuscitation (DPR) with different fluids on intestinal inflammatory response in hemorrhagic shock (HS) rats. Methods Fifty male SD rats weighing 200-250 g were randomly divided into 5 groups (n = 10 each): group Ⅰ sham operation (group S); group ⅡHS + conventional venous resuscitation (group CVR) ; group Ⅲ,Ⅳ, and Ⅴ HS + CVR + DPR with normal saline, 6% hydroxyethyl starch 130/0.4 (HES), and 2.5 % clinical peritoneal dialysis solution 20 ml respectively (group DPR1～3). The right femoral artery was cannulated for blood-letting to establish the HS model using Wiggers' method. One hour later, CVR was achieved by iv infusion of the shed blood and normal saline 2 times volume of blood loss over 30 min via an infusion pump. The 2.5 % clinical peritoneal dialysis solution 20 ml was infused into the peritoneal cavity via another infusion pump simultaneously with the start of CVR. The right common carotid artery was cannulated to monitor MAP. The blood samples were taken from the femoral artery 2 h after resuscitation to determine the lactate level. Intestinal tissues were obtained for measurement of the myeloperoxidase (MPO) activity and TNF-α expression, and microscopic examination. The intestinal mucosal damage index (IMDI) was calculated. Results There was no significant difference in MAP after resuscitation between the other 4 groups and group S (P > 0.05), while the lactate level, MPO activity, TNF-α expression and IMDI were significantly higher after resuscitation in the other 4 groups than in group S (P < 0.05 or 0.01). The lactate level, MPO activity, TNF-α expression and IMDI were significantly lower in group DPR3 than in group CVR (P < 0.05). Conclusion Direct peritoneal resuscitation with 2.5% peritoneal dialysis solution 20 ml can effectively inhibit intestinal inflammatory response and exerts protective effect on HS rats.