不同复苏液对失血性休克大鼠血中粘附分子表达的影响

目的：观察不同复苏液对失血性休克大鼠血浆血小板α颗粒膜糖蛋白-140（GMP-140）、血清可溶性血管细胞粘附分子-1（sVCAM-1）及可溶性细胞间粘附分子-1（sICAM-1）表达的影响,并探讨其可能机制。方法：50只SD大鼠随机分为5组（对照组、假手术组、休克组、林格组和万汶组）,每组10只。建立失血性休克大鼠模型后,复苏各组在失血性休克1h后给予不同复苏液（林格氏液、6%中分子羟乙基淀粉130/0.4）,复苏2h后采血,检测血浆GMP-140、血清sVCAM-1及sICAM-1的变化。结果：与对照组比较,休克组和林格组GMP-140、sVCAM-1、sICAM-1均明显升高（P〈0.01）,而万汶组改变不明显;与假手术组相比,休克组的GMP-140、sVCAM-1、sICAM-1明显升高（P〈0.01）;林格组的GMP-140亦明显升高,余两项指标未见明显变化;万汶组的GMP-140、sVCAM-1、sICAM-1改变不明显;相对于休克组,林格组的sVCAM-1下降明显（P〈0.01）,sICAM-1虽有下降,但差异无统计学意义;而万汶组的GMP-140、sI-CAM-1、sVCAM-1均明显低于休克组和林格组（P〈0.01）。结论：大鼠失血性休克可使纤溶功能亢进,血小板和凝血系统被活化;采用万汶＋林格液复苏在调节凝血功能方面优于单用林格液复苏;休克早期经充分的液体复苏后,不管是万汶还是林格液都可能会改善微循环。其可能的原因是血液稀释具有抗缺血再灌注损伤的作用,应用万汶可能减少内皮细胞损伤并改善微循环。

Effects of various of resuscitation fluids on expression of soluble cell adhesion molecules in rats with hemorrhagic shock

AIM:To investigate the changes of blood soluble adhesion molecules during hemorrhagic shock in rats and the effects of various of resuscitation fluids on expression of blood cell adhesion molecules in rats with hemorrhagic shock.METHODS:50 SD rats were divided into 5(control,sham,shock,lactated Ringer's and 6% hydroxyethylstarch)groups randomly.Lactated Ringer's group and hydroxye-thylstarch group were subjected to hemorrhagic shock for 1 h,followed by resuscitation with lactated Ringer's solution and 6% hydroxyethylstarch for 2 h by three times of the lost blood.After resuscitation,the GMP-140,sVCAM-1 and sICAM-1 were measured.At the same time,the control,the shock and the sham groups were drawn the blood to test.RESULTS:Blood plasma GMP-140,sVCAM-1 and sICAM-1 in the shock group were significantly higher than those of the control and sham group(P<0.01).Blood GMP-140,sVCAM-1 and sICAM-1 in Lactated Ringer's group were higher than those of the control group(P<0.01).Plasma GMP-140 in Lactated Ringer's group were higher than that of the sham group(P<0.01).Serum sVCAM-1 in Lactated Ringer's group was higher than that of the shock group(P<0.01).Compared with the shock group and Lactated Ringer's group,the GMP-140,sVCAM-1 and sICAM-1 were reduced in the hydroxyeth-ylstarch group(P<0.01).CONCLUSION:It is concluded that hemorrhagic shock triggers the coagulation cascade reaction,and the coagulation of the actors is greatly consumed.Unbalance of coagulation system plays an important role in the progress of shock.Resuscitation with 6% hydroxyethylstarch may reduce the inflammatory response in rats undergoing hemorrhagic shock compared to a crystalloid-based volume therapy.Hypothesize that this is most likely due to an improved microcirculation with reduced endothelial activation and less endothelial damage.