休克及复苏后不同组织能量代谢与组织损伤的差异性

背景休克后不同的组织器官循环和代谢存在一定的差异,损伤后反映也不一致,但其确切机制尚不十分清楚.目的从能量代谢的角度探讨肠组织与心肌、骨骼肌等肠外组织在休克及复苏后组织损伤的差异性.设计随机分组对照实验研究.地点和对象实验在解放军第二炮兵总医院骨科和第三军医大学完成,研究对象为健康Wistar大鼠48只,雌雄不拘,体质量(198±32)g,由解放军第三军医大学野战外科研究所实验动物中心提供.干预采用大鼠休克复苏模型,高效液相色谱法测定三磷酸腺苷(ATP)、二磷酸腺苷(ADP)和一磷酸腺苷(AMP)含量;生化及比色法测定黄嘌呤氧化酶(XO),丙二醛(MDA)和超氧化歧化酶(SOD)水平.主要观察指标休克及复苏后ATP,ADP,AMP,XO,MDA和SOD水平.结果休克后肠组织、心肌和骨骼肌ATP含量明显低于对照组,分别为对照的26.3%,30.7%和62.8%;复苏后,心肌,骨骼肌ATP含量明显高于休克组,肠组织ATP含量则略高于休克组.休克及复苏后,肠组织XO活化及MDA含量均明显高于对照组,SOD活力则明显低于对照组,其脂质过氧化程度较心肌和骨骼肌严重.结论休克及复苏后不同组织能量代谢变化及组织损伤程度存在差异性,肠组织能量代谢障碍及损伤程度重于心肌、骨骼肌等肠外组织.

Differences between energy metabolism and ischemia-reperfusion injury in different tissues after shock and resuscitation

BACKGROUND: The reaction of metabolism and circulation in different organs and tissues varies after shock. However, the exact mechanism of the variance is not clear yet.OBJECTIVE: To study the energy metabolism and ischemia-reperfusion injury in different tissues after hemorrhagic shock and resuscitation.DESIGN: A randomized controlled trial was conducted.SETTING and PARTICIPANTS: The trial was conducted in the Department of Orthopaedics, Second Artillery General Hospital of Chinese PLA and Third Military Medical University of Chinese PLA with the subjects of 48Wistar rats of either sex, weighing ( 198 + 32) g that were provided by Center for Experimental Animals, Research Institute of Field Surgery, Third Military Medical University of Chinese PLA.INTERVENTIONS: The Wistar rat model of hemorrhage shock and resuscitation was made to measure the adenosine triphosphate(ATP), adenosine diphosphate(ADP), adenosine monophosphate(AMP) by high performance liquid chromatography(HPLC) and XO, MDA, SOD by liquid phase chromatometry.MAIN OUTCOME MEASURES: ATP, ADP, AMP, XO, MDA, SOD contents in shock and post-resuscitation.RESULTS: The ATP content of jejunum, myocardium and skeleton muscle was significantly decreased after hemorrhagic shock, which was 26. 3% ,30. 7% and 62.8% of those in control group respectively. After resuscitation, the ATP content of myocardium and skeleton muscle was rapidly increased, while it was slower in intestinal tissue. During hemorrhagic shock and after resuscitation, the intestinal xanthine oxidase(XO) and malondialdehyde(MDA) were significantly increased while superoxide dismutase (SOD) decreased. The lipid peroxidation injury of jejunum was more severe than that of myocardium and skeletal muscle.CONCLUSION: There are differences in the metabolic changes and ischemia-reperfusion injury in different tissues after hemorrhagic shock and resuscitation. Moreover, the energy metabolism impairment and ischemia-reperfnsion injury of intestine are more severe than those of myocardium and skeleton muscle.