丙酮酸盐替代乳酸盐腹膜透析液腹腔复苏对失血性休克家兔肠黏膜屏障的影响

目的 观察丙酮酸盐替代乳酸盐腹膜透析液行腹腔复苏对失血性休克家兔肠黏膜屏障的影响.方法 雄性健康家兔48只以Wiggers改良方法制备失血性休克模型,将其分为常规静脉复苏组(A组)、常规静脉复苏+腹腔注射乳酸盐腹膜透析液组(B组)、常规静脉复苏+腹腔注射丙酮酸盐腹膜透析液组(C组)和静脉丙酮酸盐液复苏+腹腔注射丙酮酸盐腹膜透析液组(D组).检测休克前、休克后60 min及复苏后60、180 min静脉血二胺氧化酶(DAO)和脂多糖(LPS)水平.于观察终点取距回盲部5 cm的一段回肠,测定组织干/湿质量比、丙二醛(MDA)水平及超氧化物歧化酶(SOD)活性,并观察其病理形态学改变.结果 4组休克前血浆DAO、LPS水平比较,差异均无统计学意义(P＞0.05);休克后60 min均较休克前升高,但组间比较差异均无统计学意义(P＞0.05);复苏后60、180 min,A、B、C、D组血浆DAO、LPS水平依次降低(P＜0.05).复苏后180 min,A、B、C、D组回肠组织MDA水平依次降低(P＜0.05),SOD活力水平、组织干/湿质量比依次升高(P＜0.05),且组织损伤程度也依次减轻.结论 丙酮酸盐替代乳酸盐腹膜透析液腹腔复苏可更有效地保护失血性休克家兔肠组织细胞和减轻肠黏膜损伤.

Effect of pyruvate replacing lactate dialysis solution peritoneal resuscitation on intestinal mucosal barrier of rabbit with hemorrhagic shock

Objective To observe the effects of peritoneal resuscitation by pyruvate replacing lactate peritoneal dialysis solution on the intestinal mucosal barrier in rabbits with hemorrhagic shock.Methods The hemorrhagic shock model was prepared in 48 healthy male rabbits by adopting the improved Wiggers method.Then the rabbits were randomly divided into the conventional intravenous resuscitation group (group A),conventional intravenous resuscitation plus intraperitoneal injection of lactate peritoneal dialysis solution group (group B),conventional intravenous resuscitation plus intraperitoneal injection of pyruvate peritoneal dialysis solution group (group C) and intravenous pyruvate peritoneal dialysis solution resuscitation plus intraperitoneal injection of pyruvate peritoneal dialysis solution group (group D).The levels of diamine oxidase (DAO) and lipopolysaccharide (LPS) were measured before shock,at 60 min after shock,at 60,180 min after resuscitation.At the end of observation,the ileum tissues were taken from the 5 cm away from the ileocecal region for measuring the dry/wet ratio,malondialdehyde (MDA) level and superoxide dismutase (SOD) activity and their morphological changes was observed.Results There was no statistical difference in the plasma levels of DAO and LPS before shock among the four groups (P＞0.05);which at 50 min after shock were increased,but the comparison among the groups had no statistical difference (P＞0.05);the plasmas levels of DAO and LPS at 60,180 min after resuscitation in the group A,B,C and D were decreased in turn (P＜0.05).The MDA levels of ileum tissues after 180 min of resuscitation in the group A,B,C and D were decreased in turn (P＜0.05),but the SOD activties and tissue dry/wet mass ratios were increased in turn (P＜005),moreover the tissue injury degrees were also relieved in turn.Conclusion The peritoneal resuscitation by pyruvate replacing lactate peritoneal dialysis solution can more effectively protect the intestinal tissue cells and reduce intestinal mucosal damage in hemorrhagic shock rabbits.