羟乙基淀粉130／0．4急性高容量血液稀释对脓毒症兔肺脏的影响  

Effects of acute hypervolemic hemodilution with hydroxyethyl starch 130/0. 4 on the lung in a rabbit model of sepsis

作　　者：鲁卫华[1] 金孝岠[1] 鲁美静[1] 

机构地区：[1]皖南医学院附属弋矶山医院麻醉科,安徽芜湖241001

出　　处：《中国危重病急救医学》2009年第3期143-146,I0001,共5页Chinese Critical Care Medicine

基　　金：安徽省教委自然科学研究项目（KJ2008B323）

摘　　要：目的研究羟乙基淀粉（HES）130／0．4行中度急性高容量血液稀释（AHH）对脓毒症兔肺脏的影响，并探讨其可能机制。方法取健康新西兰兔30只，随机分为模型组、假手术组、治疗组，每组10只。采用升结肠持续引流腹膜炎（CASP）方法改良制备脓毒症兔模型，假手术组仅暴露升结肠后关腹。治疗组于术后4h测量基础值后输注HES130／0．420ml／kg行AHH，输入速率为20ml／min。3组术中均补充乳酸林格液10m1．kg^-1·h^-1。于术后4h连续监测平均动脉压（MAP）、心率（HR）；术后4h、8h开腹观察腹腔状况，同时抽取颈动脉血液测定血气及血浆肿瘤坏死因子-α（TNF—α）水平；术中监测呼吸频率及尿量。术后8h处死动物，取左肺测定湿／干重比值，观察肺组织病理学改变并行损伤评分；取右肺测支气管肺泡灌洗液总蛋白水平。结果①模型组术后4～8hMAP逐渐下降，HR逐渐加快，治疗组和假手术组变化较平稳。②治疗组稀释后血红蛋白（Hb）下降约20％，达到中度血液稀释。术后8h，模型组动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）及pH值均较假手术组下降（P均〈0．05）。③术后4h，模型组及治疗组TNF—α高于假手术组（P均〈0．05）；术后8h，与假手术组比较，模型组TNF—α升高（P〈0．05），而治疗组差异无统计学意义。④治疗组肺损伤病理学评分低于模型组[（6．9±1．4）分比（11．2±1．7）分，P〈0．053。结论对脓毒症兔予HES 130／0．4行中度AHH可减轻肺脏损害，其机制可能与减少炎症介质的释放有关。Objective To investigate the effects of acute hypervolemic hemodilution （AHH） with hydroxyethyl starch （HES） 130/0. 4 on the lung in a rabbit model of sepsis and their possible mechanism. Methods Thirty healthy New Zealand rabbits were randomly divided into three groups （n=10 each） ： group sham operation （C）, group sepsis model （E） and group AHH. Sepsis model was reproduced with modified colon ascendens stent peritonitis （CASP）. In group C laparotomy was done but without puncturing the colon. At 4 hours after CASP, AHH was carried out intravenous infusion of 6% HES 130/0.4 20 ml/kg at 20 ml/min. Lactated Ringer solution was infused at 10 ml·kg^-1· h^-1 in all three groups during the experiment. The animals breathed spontaneously during the experiment. A catheter was introduced into the right carotid artery for blood sampling, and it was connected to a pressure transducer for continuous mean arterial pressure （MAP） and heart rate （HR） monitoring. At 4 hours and 8 hours after CASP, a median abdominal incision was made and photographic documentation of abdominal situs was made. At the same time arterial blood samples were drawn at 4 hours and 8 hours after CASP for blood gas analysis and determination of hemoglobin （Hb） and hematoerit （Hot）. The plasma component was separated and tumor necrosis factor-α （TNF-α） was measured. Respiratory rate and urinary output were record. The rabbits were sacrificed at 8 hours after CASP. The right lungs were immediately removed for determination of total protein concentration in broncho-alveolar lavage fluid （BALF）. The wet/dry （W/D） lung weight rate were calculated. The sections of lung were stained with hematoxylin and eosin for light microscopic examination and the injury score was recorded. Results ①MAP declined gradually and HR tended to accelerate during the course of the experiment in group E, but no significant differences were found in both group C and group AHH. ②After AHH, the Hb and Hct decreased by 20% in g

关 键 词：羟乙基淀粉 血液稀释 脓毒症 肺脏 肿瘤坏死因子-α 

分 类 号：R686[医药卫生—骨科学]