家猪失血性休克容量复苏时内皮素和一氧化氮的变化及其与肾功能的关系  

Changes in endothelin and nitric oxide during hemorrhagic shock-volume resuscitation and their relationships with renal function in pigs

作　　者：李冬梅[1] 李文志[1] 周华成[1] 张莉莉[1] 田野[2] 衣正贵 

机构地区：[1]哈尔滨医科大学附属第二医院麻醉科,150081 [2]哈尔滨医科大学基础医学院病理与病理生理学教研室,150081 [3]辽宁省辽阳市弓长岭中心医院外科

出　　处：《中华麻醉学杂志》2009年第4期318-321,共4页Chinese Journal of Anesthesiology

基　　金：基金项目：黑龙江省教育厅基金资助项目（11511220）

摘　　要：目的探讨家猪失血性休克容量复苏时血浆内皮素（ET）和一氧化氮（NO）的变化及其与肾功能的关系。方法雄性家猪14头，体重14～17kg，随机分为2组（n=7）：假手术组（S组）和失血性休克容量复苏组（HS—VR组）。HS—VR组经股动脉放血建立失血性休克模型[通过放血和回输放出的血液维持平均动脉压（MAP）35～45mmHg，持续90min]，然后回输全部放出的血液及等容量的复方乳酸钠林格氏液进行容量复苏。S组除不放血及容量复苏，其他操作同HS—VR组。分别于放血前（基础值）、失血性休克模型制备成功时（T1）、容量复苏结束时（T2）、容量复苏结束后30min（T3）、60min（T4）、120min（T5）、240min（T6）时记录MAP、心率（HR）、中心静脉压（CVP）、肺动脉压（PAP）、肺动脉楔压（PCWP）和心输出量（CO），并于上述时点采集血样，测定血浆ET、NO、尿素氮（BUN）和肌酐（Cr）浓度，并计算ET／NO比值，ET／NO比值分别与血浆BUN、Cr浓度进行直线相关分析。结果与s组比较，T1时HS—VR组MAP、PAP、CVP和CO降低，HR增加，血浆ET、BUN和Cr浓度升高，ET／NO比值升高，T2时PAP和CVP升高，T4时HR降低，T6时PAP和ET／NO比值降低，T4-6时血浆NO浓度升高（P〈0．05或0．01）；HS—VR组血浆ET／NO比值与BUN、Cr浓度呈正相关。结论容量复苏可纠正ET与ND功能失衡，改善失血性休克家猪肾功能。Objective To evaluate the ehanges in plasma endothelin （ET） and nitric oxide （NO） concentrations during hemorrhagic shock and volume resuscitation （HS-VR） and investigate their relationships with renal function in pigs. Methods Fourteen male pigs weighing 14-17 kg were randomly divided into 2 groups （ n = 7 each）： sham operation group （S） and HS-VR group. The animals were anethestized with ketamine 15 mg/kg, diazepam 1.5 mg/kg and atropine 0.01 mg/kg. Femoral artery and vein were eannulated for MAP mornitoring, blood-letting, blood sampling and fluid infusion. Hemorrhagic shock （HS） was induced according to the method described by Wiggers and Ingraham. If MAP was reduced to 35-45 mm Hg and maintained for 90 min, the establishment of HS was considered successful. The animals were then resuscitated for 60 rain with blood transfusion and infusion of lactated Ringer＇ s solution （equal to the volume of blood loss） . MAP, HR, CVP, PAP, PCWP and CO were monitored and recorded before blood-letting （To, baseline）, after successful establishment of HS model （T1） , and immediately （T2） and at 30 min （T3）, 60 min （T4）, 120 min （T5） and 240 min （T6） after the end of resuscitation. Blond samples were obtained at the above time points for determination of concentrations of plasma ET, NO, BUN and Cr. The ET/NO ratio was calculated. The linear correlation was analyzed between plaslna ET/NO ratio and the concentrations of BUN and Cr. Results MAP, PAP, CVP and CO were significantly lower, and HR, concentrations of plasma ET, BUN and Cr higher and ET/NO ratio at T1 higher,PAP and CVP at T2 higher, HR at T4 lower, PAP and ET/NO ratio at T6 lower and plasma NO concentration at T4-6 higher in group HS-VR than in group S （ P 〈 0.05 or 0.01 ）. The plasma ET/NO ratio was positively correlated with the concentrations of BUN and Cr （ r = 0.366, 0.445, P 〈 0.01 ）. Conclusion Volume resuscitntion can improve renal function through correcting the imbalance of ET and NO in

关 键 词：休克 失血性 复苏 内皮缩血管肽类 一氧化氮 肾功能试验 

分 类 号：R459.7[医药卫生—急诊医学]