高渗溶液复苏大鼠创伤失血性休克对肠道粘膜形态学和屏障功能的影响

目的观察小容量高张溶液和大容量晶体联合小量胶体溶液分别复苏创伤失血性休克大鼠后肠道屏障功能的变化.方法SD大鼠24只按随机原则分成假创伤休克对照(Sham)组、创伤失血性休克高张溶液(HTH)组和大容量晶体(LRH)组,应用光镜、常规电镜和电镜化学技术观察小肠黏膜形态学变化,采用细菌培养技术观察肠源性细菌肠道外组织移位发生率,以判定肠道屏障功能状况.结果假创伤失血性休克组大鼠肠道黏膜层上皮细胞结构完整,固有层有少量淋巴细胞;电镜下上皮细胞膜肠腔侧微绒毛排列紧密、整齐,细胞膜完整;电镜化学技术仅偶见"暗细胞";无细菌移位现象.LRH组光镜下见黏膜上皮细胞水肿,部分细胞甚至坏死脱落形成糜烂,固有层水肿疏松,并见较多淋巴细胞及多少不等的中性粒细胞浸润;电镜下小肠黏膜上皮细胞表面微绒毛脱落,部分上皮细胞膜破损,胞浆基质外溢,有的细胞胞浆内线粒体肿胀,上皮细胞间和固有层内可见较多淋巴细胞及中性粒细胞浸润;电镜化学技术单宁酸染色可见小肠黏膜上皮"暗细胞"明显增多;细菌移位发生率达87.5%.HTH组光、电镜下形态学损伤性改变明显减轻;单宁酸染色仅见少量"暗细胞";细菌移位率仅12.5%,明显低于LRH组.结论大鼠创伤失血性休克大容量晶体复苏后肠道黏膜形态结构有明确的损伤性改变,肠道上皮层细胞膜通透性增高,导致肠道屏障功能不全、细菌移位;小容量高张溶液复苏可明显减轻肠道黏膜的损伤,改善肠道屏障功能.

Alterations of intestinal morphology and barrier function after two projects ressusciation for traumatic/ hemorrhagic shock

OBJECTIVE To investigate changes of morphological and barrier function in intestinal mucosa after two projects-large volume crystalloid combined with small volume colloid (lactic acid Ringer's solution / 6% hydroethylstarch) or small volume resuscitation for traumatic-hemorrhagic shock.METHOD The morphological alterations were examined under light microscope, electron microscope and cellular chemical technique. Blood and homogenates of mesenteric lymph nodes, livers and spleens were cultured for gut-original bacteria to evaluate gut barrier function.RESULTS 24 h after large volume crystalloid resuscitation,the histologic evidence of intestinal injury can be detected under electron microscope and cellular chemical technique as well as under light microscope. But the histologic injuries in intestinal mucosa are slighter in rats in HTH treated group. Compared the frequencies of bacterial translocation in two groups, the rate in RLH group, with the happening of 87.5%, was more higher than that in HTH group, which was 12.5%. (P<0.001).CONCLUSION The treatment for THS with small volume HTH can attenuated the intestinal mucosa barrier damage, associated with reducing frequency of bacterial translocation.