腹腔复苏在大鼠失血性休克中的治疗作用

目的:观察腹腔复苏(DPR)对失血性休克大鼠血流动力学参数、动脉血乳酸值以及小肠组织髓过氧化物酶(MPO)活性、丙二醛(MDA)含量、NO含量、湿干重比和肿瘤坏死因子-α(TNF-α)表达的影响,探讨腹腔复苏对失血性休克大鼠的保护作用及其可能的机制。方法:采用大鼠股动脉抽血法制备失血性休克动物模型。健康雄性SD大鼠50只,随机分为5组,每组10只。即假手术组(Sham组)、常规静脉复苏组(CR组)、腹腔复苏生理盐水组(DPR1组)、腹腔复苏羟乙基淀粉组(DPR2组)、腹腔复苏腹膜透析液组(DPR3组)。各DPR组在常规静脉复苏的同时行腹腔复苏。复苏后2h股动脉采血测定乳酸值,同时检测小肠组织MPO活性、MDA含量、NO含量和湿干重比,采用免疫组化法检测小肠组织TNF-α表达水平,光镜下观察小肠黏膜组织的病理变化,评估小肠黏膜上皮损伤指数。结果:与Sham组比较,CR组、DPR1组、DPR2组、DPR3组动脉血乳酸含量明显升高(P<0.01);与CR组比较,各腹腔复苏组的乳酸含量降低,但DPR3组显著降低,差异有统计学意义(P<0.05)。与Sham组比较,各休克复苏组小肠组织的MPO活性、MDA含量、湿干重比、TNF-α表达和黏膜损伤指数均显著增加(P<0.05或P<0.01);与CR组比较,各腹腔复苏组的相应指标均有所下降,但DPR3组下降显著,差异有统计学意义(P<0.05或P<0.01)。与Sham组比较,各休克复苏组NO含量均明显降低(P<0.01);与CR组比较,DPR3组NO含量有一定程度的回升,差异有统计学意义(P<0.01)。光镜下休克复苏后各组小肠黏膜上皮均有不同程度的损伤,但DRP3组这种损伤有所减轻(P<0.01)。结论:腹膜透析液行腹腔复苏对失血性休克大鼠具有保护作用。其机制可能与其抑制炎性反应、减轻组织脂质过氧化反应以及减轻组织水肿有关。

Role of Direct Peritoneal Resuscitation in Hemorrhagic Shock in Rats

Objective:To explore the effect of adjunctive direct peritoneal resuscitation on hemorrhagic shock in rats. Methods:Fifty male SD rats were randomly and equally divided into five groups as sham group,CR group (conventional resuscitation),DPR1 group (CR plus adjunctive direct peritoneal resuscitation with intraperitoneal injection of 20 ml saline),DPR2 group (CR plus adjunctive DPR with 6% hydroxyethyk starch) and DPR3 group (CR plus adjunctive DPR with a clinical peritoneal dialysis solution). Changes of lactate in the arterial blood were measured. Myeloperoxidase (MPO) activity,malondialdehyde (MDA),and NO concentrations in intestine were detected. The expression of TNF-α in intestine was measured with immunohistochemistry staining. Fluid sequestration was appraised by wet weight/dry weight ratio (WW/DW),the pathological changes in intestinal mucosa were observed under light microscope,and mucosa damage index was recorded. Results:Compared with sham group,the lactate level in the arterial blood,MPO activity,MDA concentration,and TNF-α expression were higher,and NO level was lower in intestine after resuscitation from hemorrhagic shock. However,the changes in DPR3 group were milder (P<0.05,or P<0.01). Adjunctive DPR with a peritoneal dialysis solution prevented the CR-mediated fluid sequestration in gut and maintained a relative normal tissue water compared with CR alone or adjunctive DPR with other two kind of solutions (P<0.05). The intestinal mucosa pathological analysis showed severe damage in CR,DPR1,and DPR2 group,slight damage in DPR3 group and no obvious damage in sham group. Conclusion:Adjunctive direct peritoneal resuscitation with a clinical peritoneal dialysis solution might produce a protective effect on hemorrhagic shock. It lightens the inflammatory response,relieves the intestinal lipid peroxidation,promotes early fluid mobilization,and prevents edema formation.