目标导向液体治疗对失血性休克犬输液量及肺水通道蛋白1、5的影响

目的 探讨目标导向液体治疗（goal-directed fluid therapy,GDFT）对失血性休克犬输液量及肺水通道蛋白（Aquaporins,AQP）1、5表达的影响.方法 32只比格犬随机分为4组（每组8只）：假手术组（S组）,目标导向液体治疗组（G组）,中心静脉压指导输液组（C组）及定量输液组（Q组）.G组、C组和Q组建立失血性休克模型并维持休克状态60 min,随后分别采用GDFT、定量输液和中心静脉压指导的输液方案行液体复苏并观察4h.复苏液体乳酸林格氏液与羟乙基淀粉的输液比例为1：1.实验结束后,记录复苏4h的输液量及尿量;测定肺组织的湿/干重量比（W/D）;通过RT-PCR及Western-blot检测肺组织AQP1和AQP5的表达.结果 G组的输液量及尿量多于Q组和C组（P＜0.05）;G组肺组织的W/D高于S组、Q组和C组（P＜0.05）;G组肺组织AQP1和AQP5的表达和S组、Q组及C组比较差异无统计学意义（P＜0.05）.结论 目标导向液体治疗会造成失血性休克犬的输液量增加,但不影响肺组织水通道蛋白1、5的表达.

The Effects of Goal-directed Fluid Therapy on the Amount of Infusion and the Expression of Pulmonary Aquaporin1 and Aquaporin5 in Hemorrhagic Shock Dogs

Objective To investigate the effects of goal-directed fluid therapy （GDFT） on the amount of infusion and the expression of pulmonary aquaporins （AQP1 and AQP5） in hemorrhagic shock dogs.Methods Thirty-two beagle dogs were randomly divided into four groups,sham operation group （group S,n =8）,and three treated groups：GDFT group （group G,n =8）,central venous pressure-directed fluid therapy group （C group,n =8）,quantity-directed fluid therapy group （Q group,n =8）.The hemorrhagic shock model was established with the modified Wigger＇s method and maintained 60 minutes.Then three strategyies of fluid resuscitation was administrated to group G,group C as well as group Q and observation for 4 hours.Stroke volume variation （SVV） below 10％ was regared as targeted goal of group G,a fluid each bolus 2ml/kg of lactated Ringer＇s and hydroxyethyl starch was administered within 10 min when SVV exceed 10％.The resuscitation fluid was infused with lactated Ringer＇s/hydroxyethyl starch 1：1ratio.Autologous blood was infused and maintenanced the hemoglobin between 100 and 110 g/L.After 4 hours of resuscitation,the fluid volume and the urine output were recorded.Then lung tissue was sampled to detection the expression of AQP1 and AQP5 by RT-PCR and Western-blot; measure values of wet-to-dry lung weight ratio （W/D）.Results Compared with the S group,Q group and C group,the amount of infusion and lung wet-to-dry weight ratio in G group was significantly increased.No difference was found in the expression of the AQP1 and AQP5 in all groups.Conclusion GDFT may increase the amount of infusion in hemorrhagic shock dogs,but has no effect on the expression of pulmonary AQP1 and AQP5.