不同方式液体复苏对失血性休克大鼠外周血单个核细胞中核转录因子-κB活性的影响

目的观察失血性休克大鼠外周血单个核细胞（PBMC）中核转录因子-κB（NF—κB）活性的变化以及不同方式液体复苏对其的影响。方法将32只成功复制的失血性休克模型SD大鼠随机分为对照组、无液体复苏组、限制性液体复苏组和快速大量液体复苏组，每组8只；比较各组的救治疗效，并用酶联免疫吸附法（ELISA）检测各组PBMC中NF—κB活性的变化。结果限制性液体复苏组大鼠的存活时间较快速大量液体复苏组及无液体复苏组明显延长（P均〈0．05）；限制性液体复苏组大鼠72h存活率明显高于快速大量液体复苏组和无液体复苏组，但低于对照组（P均〈0．05）。除对照组外，其余各组创伤后60min和120min PBMC中NF—κB活性均较创伤前有明显升高，且120min较60min也明显升高（P均〈0．05）；限制性液体复苏组NF～κB活性明显低于快速大量液体复苏组和无液体复苏组（P均〈0．05）；死亡组创伤后60min和120min NF—κB活性明显高于存活组（P均〈0．05）。结论限制性液体复苏可显著降低失血性休克大鼠的72h死亡率；PBMC中NF—κB活性与预后密切相关，NF—κB活性高则提示预后不良，而限制性液体复苏时NF-κB活性明显降低，有助于改善预后。

Effects of different means of fluid resuscitation on the activity of nuclear factor - κB in peripheral blood mononuclear cells in rats with hemorrhagic shock

OBJECTIVE: To observe the effects of different means of fluid resuscitation on the activity of nuclear factor-KappaB (NF-KappaB) in peripheral blood mononuclear cells (PBMC) in rats with hemorrhagic shock. METHODS: Rat models of hemorrhagic shock were reproduced using the modified Capone method. Thirty-two SD rats were randomly divided into four groups: control group, no fluid resuscitation group, limited fluid resuscitation group, large quantity fluid rapid resuscitation group (each n=8). The survival time and survival rate of each group were compared. The activities of NF-KappaB in PBMC were assessed with enzyme-linked immunosorbent assay (ELISA). RESULTS: The survival time of limited fluid resuscitation group was longer than that of large quantity fluid rapid resuscitation group and that of no fluid resuscitation group (both P<0.05). The 72-hour survival rate in limited fluid resuscitation group was higher than that in large quantity fluid rapid resuscitation group and also in no fluid resuscitation group, while lower than that of control group (all P<0.05). The activities of NF-KappaB in PBMC increased significantly 60 and 120 minutes after injury compared with those before injury except control group, that of 120 minutes was higher than 60 minutes (all P<0.05). The activities of NF-KappaB in limited fluid resuscitation group was lower than those in large quantity fluid rapid resuscitation group and also in no fluid resuscitation group (all P<0.05). The activities of NF-KappaB in the died rats were higher than those of the survivors 60 and 120 minutes after injury (both P<0.05). CONCLUSION: The results of our study demonstrate that the limited fluid resuscitation during hemorrhagic shock could raise the 72-hour survival rate and prolong survival time. The poor prognosis of hemorrhagic shock was associated with high NF-KappaB activity in PBMC, which could be lowered with limited fluid resuscitation.