非控制性失血性休克肠系膜淋巴循环的变化

目的 非控制性失血性休克(UHS)是现代战创伤休克最常见的休克类型.肠道淋巴系统在休克及MODS中扮演重要角色.本实验对UHS肠淋巴流量、蛋白及内毒索含量进行了研究.方法 SD大鼠38只,分为对照组(n=10)、出血已控制的失血性休克(CHS)组(n=10)及UHS组(n=10).左股动、静脉及右颈动脉插管,用自制的金属导管穿刺肠系膜主淋巴管,持续引流淋巴液.将动物放血到血压为40 mmHg后,在距鼠尾根部25%处截断,使鼠尾残端活动性出血,造成UHS.连续观察3 h,监测MAP,CVP,记录淋巴流量,检测血浆及淋巴液蛋白及内毒素含量.数据比较采用方差分析和χ2检验.结果 休克后肠系膜淋巴流量急剧减少到正常流量的1/4以下.失血控制后,肠系膜淋巴流量缓慢增加,而UHS动物肠淋巴流量及淋巴蛋白输出量呈持续性下降.CHS组淋巴液内毒素自伤后2 h开始升高,而UHS组则自伤后1 h就外始升高,至伤后2 h,两组差异具有统计学意义(P<0.05).结论 失血性休克大鼠肠系膜淋巴流最及蛋白输出量非常显著下降,淋巴液内毒素含量显著升高;且UHS比CHS更显著.这可能足非控制性失血性休克导致MODS的重要原因之一.

Variation in the circulation of mesenteric lymph fluid during uncontrolled hemorrhagic shock

Objective To identify the changes of mesenteric lymph fluid in cases of uncontrolled hemor-rhagic shock (UHS), which is most often occurred in modem trauma and battle injury. The lymph of gut plays an important role during shock and MODS. The objective of this experiment is to identify the change of mesenteric lymph fluid in UHS. Method Thirty-eight SD rats were canulated with PE 50 catheters separately into right carotid artery,left femoral artery and femoral vein. A serf-made steel catheter was inserted into main mesenteric lymph duct and the mesenteric lymph fluid was collected. The rots were divided into three groups: control group (n=10), controlled hemorrhagic shock (CHS) group (n=10) and UHS group (n=10). After the mean blood pressure was dropped to 40 mmHg by exsanguination, hemorrhage was made by amputation of 75% tail in length and let the stump keep open to bleed. The volume of mesenteric lymph fluid was recorded, and the protein and endotoxin in it were examined, too. Data were analyzed using ANOVA and Chi-square test. Results The mesenteric lymph fluid was decreasing remarkably during shock until it was below 1/4 of normal. After hemorrhage was controlled, the mesentefic lymph fluid increased slowly. However, it kept decreasing persistently in cases of UHS. So did the protein content. The eudotoxin in lymph fluid increased 2 hours after CHS and one hour after UHS. There was significant difference in endotoxin between CHS and UHS 2 hours after shock (P<0.05). Con-dusions The volume and protein content of mesenteric lymph fluid decreased mare significantly in UHS than that in CHS. And contrarily, the endotoxin in lymph fluid increased more significantly in UHS than that in CHS. The change of the mesenteric lymph fluid may be an important cause of MODS after UHS.