早期液体复苏对严重烫伤大鼠肝脏脂肪变性的疗效观察

目的观察早期液体复苏对严重烫伤大鼠肝脏脂肪变性的治疗效果。方法选择健康成年SD大鼠144只,随机分为4组。麻醉后假伤组背部给予30％TBSA的模拟烫伤。其余大鼠背部给予30％TBSAⅢ度烫伤,之后分为单纯烫伤组:烫伤后不补液;早期复苏组:烫伤后立即按Park- land公式用复方乳酸钠林格液进行复苏;延迟复苏组:烫伤后6 h给予液体复苏,方法同早期复苏组。分别于伤后0．5、1．0、2．0、3．0、7．0及21．0 d取各组大鼠肝脏组织,利用光学显微镜、透射电镜观察其病理变化。在相同时相点采集大鼠下腔静脉血,检测血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、碱性磷酸酶(ALP)的含量。分别于采血前测量各组大鼠体重,采血后取完整肝组织称重并计算肝重:体重比值。进行统计学相关分析。结果早期复苏组大鼠肝细胞脂肪变性程度明显轻于其余两烫伤组。大鼠伤后各时相点TC、TG、ALP的含量按早期复苏组、延迟复苏组、单纯烫伤组顺序依次增高,HDL的含量依次降低。伤后大鼠肝重:体重比值升高,伤后1．0 d延迟复苏组与早期复苏组比较差异有统计学意义(P<0．05);伤后7．0 d,单纯烫伤组、延迟复苏组与早期复苏组比较,差异有统计学意义(P<0．01)。严重烫伤后肝脏脂肪变性程度与HDL含量呈显著负相关(r= -0．37,P<0．01),与ALP含量呈显著正相关(r=0．45,P<0．01),与TG含量呈显著正相关(r= 0．25,P<0．01),与肝重:体重比值呈显著正相关(r=0．44,P<0．01)。其他指标与烫伤后肝脏脂肪变性程度无相关性。结论及时有效的液体复苏可以减轻烫伤大鼠肝脏脂肪变性的严重程度,降低其发生率,有利于促进肝细胞损害的尽早恢复。

Observation of the effect of early fluid resuscitation on hepatic fatty degeneration in rats after severe scald

Objective To investigate the efficacy of early fluid resuscitation on hepatic steatosis in rats after severe scald. Methods One hundred and forty-four Sprague-Dawley rats were enrolled in the study. In thirty-six rats skin of 30% TBSA was treated with cold water to serve as sham injury group. All other rats were inflicted with 30% full-thickness scald, and they were subdivided into 3 groups, i. e. scald group(S, without resuscitation), delayed resuscitation group (DR, with Ringer's solution at 6 post-scald hour(PSH)) and early resuscitation group(ER, with Ringer's solution immediately after scald). The hepatic tissues of the rats were harvested at 0.5,1.0,2.0,3.0,7.0 post-scald hour(PSH) and on 21.0 PSD for the observation of pathological changes with light-microscope and transmission electron microscope. The serum contents of TC, TG, HDL, ALP were determined at the same time-points. Body weight of each rat was measured before blood sampling, and total liver weight after blood sampling. Liver weight/body weight ratio was recorded. Results Compared with sham injury group, the fat denatuation degree of hepatic tissue in ER group was obviously less than that in S and DR group . The serum level of high density lipoprotein (TC) , triglyceride(TG) , and alkaline phosphatase (ALP) after scald increased ranking as S>DR>ER, while the level of HDL decreased in that order. The liver weight/body weight ratio of the rats in DR group on 1.0 PSD was obviously elevated compared with that in ER group(P<0.05) , and there exhibited significant difference of liver weight/body weight ratio between DR and ER groups on 7.0 PSD (P<0.01). The liver steatosis had obvious negative correlation with HDL content after scald(r=-0.37 , P<0.01) , but it had positive correlation with the ALP content(r=0.45 , P<0.01) , TG content(r=0.25 , P<0.01) and liver weight/body weight ratio(r=0.440, P<0.01). The remaining parameters showed no correlation with the liver steatosis. Conclusion Fluid resuscitation immediately after scald can ameliorate hepatic fatty degeneration, reduce its incidence, and beneficial to recovery of liver damage to a certain extent.