大鼠高位脊髓损伤并创伤失血休克后急性期神经内分泌变化对器官血流量的影响  

Effects of neuroendocrine on organ regional blood flow in traumatic hemorrhagic shock rats combined with spinal cord injury during acute stage

作　　者：刘育杰[1] 沈岳[1] 王爱民[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所全军战创伤中心骨创伤科,重庆400042

出　　处：《创伤外科杂志》2008年第3期214-218,共5页Journal of Traumatic Surgery

摘　　要：目的研究大鼠高位脊髓损伤并创伤失血休克后急性期器官血流量及血清去甲肾上腺素(NE)、肾上腺素(E)、神经肽Y(NPY)浓度变化规律。方法实验1:将27只SD大鼠随机分为假手术组(A组,7只)、创伤失血组(B组,胫骨骨折并失血,10只)、多发伤组(C组,高位脊髓损伤合并胫骨骨折及失血,10只),B、C组伤后平均动脉压(MAP)维持在40mmHg并记录总失血量。利用彩色微球技术检测伤后器官血流量变化并计算总外周血管阻力(TPR)和心排出量(CO)。实验2:另取SD大鼠复制B、C组模型(每组10只),于伤后不同时间点抽取动脉血,利用酶联免疫吸附法测定血清NE、E浓度,放射免疫法测定NPY浓度。结果C组血压降至40mmHg总失血量显著低于B组(P<0.01)。B组伤后1小时,心、脑血流量降幅显著低于其它器官(P<0.01),器官血流量出现重新分布。TPR在伤后1小时显著增加,随后显著降低。伤后各时间点CO均显著降低,血清NE、E、NPY显著增高(P<0.01)。C组伤后1、3、6小时各器官血流量均显著降低(未出现重新分布),CO、TPR均显著下降,血清NE、E、NPY轻度增高。结论大鼠高位脊髓损伤并创伤失血伤后急性期,各器官血流量未出现重新分布。血清NE、E、NPY相对不足可能是其原因之一。Objective To investigate changes of organ regional blood flow（RBF） in traumatic hemorrhagic shock rats combined with spinal cord injury in vivo and the serum norepinephrine（NE）,epinephrine（E） and neuropeptide Y（NPY） concentration during acute stage.Methods Twenty-seven SD rats were divided into 3 groups in the first part of experiments： sham-operation（Group A）,animals combined with hemorrhage and tibia fracture（Group B） and animals combined with spinal cord injury,hemorrhage and tibia fracture（Group C）.The MAP of Group B and C were maintained at 40mmHg after trauma and total volume of lost blood were recorded.The RBF of the organs was monitored by color-labeled microspheres technique after trauma,and total peripheral resistance（TPR） rise and cardiac output（CO） were calculated.In the second part,twenty SD rats were randomly divided to 2 groups using the same injury as that found in Group B,C to measure the concentration of serum NE,E（ELISA assay）,NPY（radioimmunity assay）after trauma.Results The total volume of lost blood in group B was significantly higher than group C（P〈0.01） to maintain MAP at 40 mmHg.RBF of heart and brain showed a slight drop while other organs dropped dramatically at 1 h after trauma.RBF exhibited redistribution.TPR increased at 1 h and dropped at 6 h after trauma.CO dropped dramatically,and serum NE,E,NPY increased dramatically after trauma（P〈0.05） in group B.However,RBF,TPR and CO in Group C dropped uniformly and serum NE,E,NPY concentration increased slightly after trauma（P〈0.05）.Conclusion The organ RBF in traumatic hemorrhagic shock rats combined with spinal cord injury do not exhibit redistribution as compared with rats of traumatic hemorrhagic shock early after trauma.That phenomenon could be partly due to the relative shortage of serum NE,E,NPY after trauma.

关 键 词：脊髓损伤 失血性休克 血流量 多发伤 

分 类 号：R605.971[医药卫生—急诊医学] R651.2[医药卫生—外科学]