血管加压素院前维持血压对非控制性出血性休克大鼠器官血流灌注及功能的影响

目的 观察早期应用精氨酸血管加压素(AVP)维持血压对非控制出血性休克大鼠器官血流灌注和功能的影响。方法 96只SD大鼠分为2组：AVP(5×10_-4 U/ml)组和低压复苏对照组。复制非控制出血性休克模型,观察早期(模拟院前救治阶段)应用AVP维持血压(50 mmHg,3 h)对休克动物的心功能指标和组织氧供/氧耗、肝/肾血流量、肝/肾功能及其线粒体功能的影响。结果 在院前救治阶段,应用AVP维持血压可明显改善心功能指标,提高心输出量和增加组织氧供/氧耗；同时AVP治疗也明显提高了肝血流量、改善肝线粒体功能,并明显降低了休克后升高的肝功能指标AST和ALT,其效果明显优于单纯低压复苏组。但AVP组的肾血流量低于低压复苏组,且两组间肾线粒体功能和肾功能指标(BUN和Scr)无明显差异。结论 院前救治阶段应用AVP可更有效的改善心功能、改善重要器官的血流灌注和线粒体功能,发挥抗休克作用。但AVP对肾功能的影响需进一步研究。

Effects of Pre-hospital administration of AVP to Maintain the Blood Pressure on Blood Perfusion and Organ Function of Uncontrolled Hemorrhagic Shock Rats

ABSTRACT: OBJECTIVE To investigate the effects of arginine vasopressin (AVP) on blood perfusion and organ function of uncontrolled hemorrhagic shock rats when used during the pre-hospital period. METHODS Ninety-six SD rats were divided into 2 groups: AVP (5×10-4 U/ml) with hypotensive resuscitation groups and hypotensive resuscitation control group. Uncontrolled hemorrhagic shock model was adopted, the effects of early administration (to mimic the pre-hospital treatment period) of AVP to maintain the blood pressure (50 mmHg, 3 h) on cardiac function, blood perfusion, vital organ and mitochondrial function were observed. RESULTS During the pre-hospital period, application of AVP significantly improved the cardiac function, increase cardiac output and oxygen delivery and oxygen utilization, improve hepatic blood flow, protect the hepatic function and mitochondrial function in shock rats, as compared with hypotensive resuscitation alone (P<0.05 or 0.01). But the renal blood flow in AVP group was lower than that in hypotensive resuscitation group, and the renal function and its mitochondrial function were not different between the two groups. CONCLUSION Prehospital AVP therapy effectively improved cardiac function, increased tissue blood flow and protected mitochondrial function, final played the anti-shock effects. But the role of AVP on renal function following shock needs further elucidation.