限制性液体复苏对失血性休克孕兔肺缺血再灌注损伤的保护作用  

Protective Effect of Limited Fluid Resuscitation on Pulmonary Ischemia-reperfusion Injury in Pregnant Rabbits with Hemorrhagic Shock

作　　者：王晨虹[1] 涂新枝[1] 张铨富[1] 余艳红[2] 龚时鹏[2] 胡冬煦[3] 

机构地区：[1]南方医科大学附属深圳市妇幼保健院,深圳518028 [2]南方医科大学附属南方医院妇产科 [3]湖南医科大学附属湘雅二院

出　　处：《医学研究杂志》2008年第3期42-45,共4页Journal of Medical Research

基　　金：广东省重大社会问题联合攻关项目基金资助(ZKB04701S)

摘　　要：目的探讨早期限制性液体复苏对未控制性重度失血性休克孕兔肺缺血再灌注损伤的保护作用。方法15只孕兔制成未控制重度失血性休克模型,随机分为假休克组(P组)、传统液体复苏组(TFR组)、限制性液体复苏组(LFR组),分别于实验0min、90min、180min和4h检测和比较各组血清SOD、MDA和TNF-α的含量,并在实验4h处死孕兔,比较各组左肺干湿质量比(DW/WW)。结果缺血再灌注后两个治疗组血清SOD含量持续下降,TNF-α和MDA的含量持续上升。LFR组SOD和肺DW/WW明显高于TFR组,但低于P组;而LFR组TNF-α和MDA含量明显低于TFR组,但高于P组。结论早期限制性液体复苏能减少缺血再灌注时氧自由基的产生和炎症介质释放,减轻肺缺血再灌注损伤,是临床上产科未控制重度失血性休克早期救治的理想复苏方案。Objective To investigate the protective effect of limited fluid resuscitation on pulmonary ischemia - reperfusion injury in pregnant rabbits with severe uncontrolled obstetrical hemorrhagic shock. Methods The model of severe uncontrolled hemorrhagic shock was established in 15 pregnant rabbits. The rabbits were randomly assigned to pseudo shock group （P group）, traditional fluid resuscitation group （TFR group） , and limited fluid resuscitation group （LFR group）. We detected and compared the values of serum SOD,MDA and TNF-α at 0min, 90 minutes, 180 min and 4 hours. The pregnant rabbits were sacrificed 4 hours later, and then the dry to wet weight ratio of left pulmonary tissue （ DW/ WW） were measured and compared. Results After ischemia - reperfusion injury, the values of serum SOD in two therapeutic groups decreased persistently, but the values of TNF - α and MDA increased. The values of SOD and pulmonary DW/ WW ratio in LFR group were significantly higher than those in TFR group, which were lower than in P group. The values of serum TNF - α and MDA in LFR group were significantly lower than those in TFR group which were higher than in P group. Conclusion Initial limited fluid resuscitation can reduce oxygen free radicals by ischemia -reperfusion, reduce release of inflamed medium, and improve immune response. So initial limited fluid resuscitation can relieve pulmonary ischemia- reperfusion injury, which may be an ideal curative method for severe uncontrolled hemorrhagic shock in pregnant women.

关 键 词：限制性液体复苏 失血性休克 缺血再灌注损伤 肺 

分 类 号：R563[医药卫生—呼吸系统] R605.971[医药卫生—内科学]