游离血红蛋白对猪失血性休克模型的损伤作用  

Free hemoglobin augments the injury effects of hemorrhagic shock on pigs

作　　者：杨俊驰[1] 薛绪潮 钱宝华[2] 吴波[1] 王尧[1] 

机构地区：[1]第二军医大学长海医院普外科,上海200433 [2]第二军医大学长海医院输血科

出　　处：《中国输血杂志》2009年第6期460-463,共4页Chinese Journal of Blood Transfusion

摘　　要：目的探讨游离血红蛋白(FHb)对猪失血性休克的损伤作用。方法制作创伤失血性休克动物模型,随机分为休克+自体血复苏组(A组)、休克自体血复苏+输注10mg/kgHb(B组)、休克自体血复苏+输注15mg/kgHb(C组)、休克自体血复苏+输注20mg/kgHb(D组)、休克自体血复苏+输注25mg/kgHb(E组)。模型完成后,分别于复苏后的0、6、12、24、48h时间点测定血浆FHb、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、血肌酐(Cr)、尿素(BUN)水平。48h后处死动物,取肝、肾组织做光镜检查。结果A组FHb水平无显著变化;休克复苏中输入FHb,血浆FHb水平持续升高至6h达峰值;B、C组在复苏后24h,D组在复苏后48h血浆FHb回复至初始水平;E组复苏48h血浆FHb仍维持较高水平。D组ALT、AST水平在复苏后12、24h;TBIL、Cr水平在复苏后6、12、24h;BUN水平在复苏后6、12、24、48h;E组ALT、AST、TBIL、Cr水平在复苏后6、12、24h;BUN水平在复苏后6、12、24、48h均显著增高(P<0.05);B、C组肝肾功能指标水平无明显变化。病理结果:光镜下观察,A、B、C、D4组肝脏组织无明显损伤,E组可见肝细胞变性、坏死;大量枯否细胞增生、变形;A、B2组肾脏组织无明显损伤,C组肾小管内皮水肿,呈纤毛状改变,管腔狭窄,有蛋白管型和细胞管型,D组较C组严重,较E组为轻,E组可观察到肾小管变性、坏死。结论复苏时输注高剂量Hb(20—25mg/kg),可加重休克对肝、肾功能及组织结构的损伤。Objective To investigate the injury effects of free hemoglobin on hemorrhagic shock pigs. Methods The model of hemorrhagic shock was established. The 30 pigs were randomly divided into five groups：hemorrhagic shock pigs treated by plasma group （n =6） ;treated by plasma with 10 mg/kg free hemoglobin （n =6） ;treated by plasma with 15 mg/ kg free hemoglobin （n =6） ;treated by plasma with 20 mg/kg free hemoglobin （n =6） ;treated by plasma with 25 mg/kg free hemoglobin （ n = 6） . AST, ALT,TBIL, BUN and Cr in each group were measured at 0,6,12,24 and 48 h at different time. In every group, pigs were killed and the pathological changes of liver and kidney were observed by light microscopy. Results After the infusion of free hemoglobin, the level of hemoglobin increased significantly and reached peak level at 6h. The hemoglobin level leached normal at 24 h in group B,so did group C. In group D,the level decreased at 48 h. However,the level of hemoglobin remained high in group E at 48h. The level of ALT was significantly higher in the group D and group E at 12,24 h and 6,12,24 h,respectively （P 〈 0. 05 ）, as well as AST. The levels of TBIL and Cr in groups above were significantly higher at 6,12,24 h（ P 〈 0. 05 ）. The level of BUN in groups above were significantly higher at 6,12,24, 48 h（ P 〈0. 05）. Cloudy swelling and hyperemia were observed in the group B and C,which eertifyied little injury in kidney and liver tissues. In the group D and E, necrosis was observed in hepatic sections, as well as nephrie tubule stenosis and necrosis in renal sections under light microscopy. Conclusion Infusion of free hemoglobin during the resuscitation augments the effects of injury of hemorrhagic shock and the effects are reinforced following the increase of hemoglobin level.

关 键 词：肝功能 肾功能 游离血红蛋白 失血性休克 

分 类 号：R331.141[医药卫生—人体生理学] R457.1[医药卫生—基础医学]