腹腔复苏对失血性休克大鼠小肠黏膜的保护作用  

The protective effects of intra-peritoneal fluid resuscitation on small intestinal mucosa in rats with hemor- rhagic shock

作　　者：路小光[1] 康新[1] 王屹刚[1] 范治伟[1] 刘莉[1] 康利民[1] 王迎莉[1] 白黎智[1] 庞洪刚[1] 郭帅[1] 杨广新[1] 

机构地区：[1]大连大学附属中山医院急诊科,辽宁省大连116001

出　　处：《中华急诊医学杂志》2010年第5期470-475,共6页Chinese Journal of Emergency Medicine

摘　　要：目的探讨腹腔复苏对失血性休克大鼠小肠黏膜的保护作用。方法健康雄性SD大鼠50只随机（随机数字法）分成5组：假手术组（工组）、失血性休克组（Ⅱ组）、静脉复苏组（Ⅲ组）、静脉复苏加生理盐水腹腔复苏组（Ⅳ组）、静脉复苏加PD-2液腹腔复苏组（V组）。I组依次行右颈总动脉、右股静脉、左股动脉插管及全身肝素化；Ⅱ组在I组基础上经左股动脉放血制备失血性休克大鼠模型；Ⅲ组在造模后经右股静脉补入放出的血量及2倍量林格氏液进行复苏；IV组和V组分别在Ⅲ组基础上经腹腔内注入生理盐水、2．5％PD．2液各30mL。各组分别于造模及复苏后60～120min取材。测定血浆二胺氧化酶（DAO）活性、D哥L酸（D—LA）含量及内毒素（LPS）含量，光镜和电镜下观察大鼠小肠黏膜组织学和超微结构变化。采用单因素方差分析对数据进行统计学处理。结果Ⅱ组血浆DAO活性、D-LA及LPS含量均较I组明显升高，差异具有统计学意义（P〈0．01）；V组分别与Ⅱ、Ⅲ及Ⅳ组比较，血浆DAO活性、D—LA及LPS含量差异有统计学意义（P〈0．05orP〈0．01）。各组小肠黏膜组织病理学及黏膜超微结构比较，Ⅱ组较I组有明显损伤，V组较Ⅱ、Ⅲ及Ⅳ组损伤明显减轻。结论PD-2液腹腔复苏可减轻失血性休克大鼠小肠黏膜组织病理学损害，保护肠黏膜完整性，降低肠壁通透性，防止内毒素血症发生。Objective To investigate the protective effects of intra-peritoneal fluid resuscitation on small intestinal mucosa in rats with hemorrhagic shock. Method Fifty Sprague-Dawley （SD） rats were randomly（random number） divided into five groups, namely sham operation group （group I ）, hemorrhagic shock group （group II ）, intra-venous fluid resuscitation group （group Ⅲ ）, intravenous fluid resuscitation plus intra-peritoneal saline resuscitation （group IV ） and intravenous fluid resuscitation plus intra-peritoneal PD-2 solution resuscitation group （group V ）. The rats of 5 groups were processed with cannttlations of fight common carotid artery, right femoral vein and left femoral artery with systemic heparinization. The rat models of hemorrhagic shock were established with modified Wigger＇ s method by which the blood exsanguinated from left femoral artery. The rats of group Ⅲ were resuscitated with shed blood plus twice equal volume of Ringer＇ s solution after modeling of hemorrhagic shock. The rats of group IV; and group V were administered intra-peritoneally with 30 mL saline and 30 mL of 2.5% PD-2 solution, respectively as adjuncts to those used in the group Ⅲ . The specimens of blood and small intestine of rats of all groups were collected 60 - 120 minutes after modeling and resuscitation. The activity of plasma diamine oxidase （DAO） was determined with chromatometry, the level of plasma D-lactic acid （D-LA） with spectorophotometry and the level of plasma lipopolysaocharide （LPS） with nephelometry. The histopathological and uhrastructure changes of small intestine tissue of rats were observed under light microscope and electronic microscope. Results There were remarkable differences in activity of DAO, and the levels of D-LA and LPS in rats between those in group II and group i （ P 〈 0.01 ）, and between those in group V and groups II , Ⅲ or IV（ P 〈 0.05 or P 〈 0.01 ） The pathomorphology and ultra-structure of small intestine tissues were severely danl

关 键 词：失血性休克 小肠黏膜 腹腔复苏 菌群移位 多器官功能障碍综合征 二胺氧化酶 D-乳酸 内毒素 

分 类 号：R459.7[医药卫生—急诊医学]