高渗氯化钠羟乙基淀粉40注射液小容量复苏对内毒素休克大鼠小肠损伤的影响  

Small volume resuscitation of hypertonic sodium chloride hydroxyethyl starch 40 reduced intestinal mucosa injured in endotoxic shock rats

作　　者：庞红宇[1] 陈景晖[1] 罗晨芳[1] 沈宁[1] 黑子清[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630

出　　处：《中国新药与临床杂志》2012年第4期210-214,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的探讨高渗氯化钠羟乙基淀粉40注射液(HSH)小容量复苏对内毒素休克大鼠小肠损伤的影响。方法清洁级SD大鼠30只随机分为5组:正常对照组(N组)、内毒素休克组(E组)、7.5%高渗氯化钠组(HTS组)、羟乙基淀粉130/0.4氯化钠注射液组(HES组)和高渗氯化钠羟乙基淀粉40注射液组(HSH组)。静注脂多糖(LPS)1 mg·kg^(-1)制作休克模型,30 min后分别予不同液体小容量复苏(4 mL·kg^(-1))。90 min后处死大鼠,HE染色观察小肠病理变化,取小肠组织检测硫化氢(H_2S)、一氧化氮(NO)、超氧化物歧化酶(SOD)、丙二醛(MDA)、肿瘤坏死因子α(TNF-α)。结果内毒素休克大鼠小肠出现明显的病理改变,如黏膜断裂,上皮细胞水肿、脱落,肠内出血,炎症浸润等,而不同液体小容量复苏组的上述改变则有不同程度减轻,HSH组肠组织损伤分级评分显著低于HTS组(P<0.05),略低于HES组,但无显著差异(P>0.05)。E组大鼠小肠匀浆液中H_2S、NO和TNF-α含量及MDA较N组显著增高(P<0.05),SOD活性显著下降(P<0.05);3种液体复苏组与E组比较,H_2S、NO和TNF-α含量及MDA水平显著降低,SOD活性显著增高(均P<0.05)。HSH组H_2S和NO含量明显低于HTS组和HES组(P<0.05);HSH组TNF-α含量和MDA水平明显低于HTS组,SOD活性明显高于HTS组(P<0.05),但均与HES组无显著差异(P>0.05)。各组大鼠小肠干湿重比未见有明显差异(P>0.05)。结论内毒素休克大鼠使用HTS、HES、HSH三种液体小容量复苏后,小肠的炎症、氧化应激、病理损伤有不同程度减轻。HSH复苏效果明显优于HTS,与HES无显著差异。AIM To investigate the effects of small-volume resuscitation with hypertonic sodium chloride hydroxyethyl starch 40 （HSH） on intestinal mucosa injured in endotoxic shock rats. METHODS Thirty SD rats weighting 180 - 250 g were randomly divided into 5 groups （n = 6） ： blank control group （N group）, model group （E group）, and hypertonic sodium chloride group （HTS group）, hydroxyethyl starch 130/0.4 injection group （HES group）, hypertonic sodium chloride hydroxyethyl starch group （HSH group）. Resuscitation fluids were administrated 30 min after lipopolysaccharide （LPS） injected. Rats were executed and parts of intestines were taken out at 90 min later. Pathological examination was observed with HE staining under light microscope. Hydrogen sulfide （H2S） , nitric oxide （NO） , superoxide dismutase （SOD）, malondialdehyde （MDA） , and tumor necrosis factor-α （TNF-α） of intestinal were detected. RESULTS Endotoxin shock rats were observed significant pathological changes such as intestinal mucous membrane rupture, epithelial cells desquamation, hemorrhage in enteric cavity, and inflammatory infiltration. While the changes were slightly in the HSH group and the HES group when compared with the E group. Intestinal tissue injury scale scores of the HSH group were significantly lower than the HTS group （P 〈 0.05） , slightly lower than the HES group, but no significant difference （P 〉 0.05）. Compared with the N group, H2S, NO, TNF-α and MDA of intestinal homogenate in the group E increased significantly, though SOD activity decreased significantly. HiS, NO, TNF-α and MDA of the three resuscitation groups decreased significantly, and SOD increased significantly, when compared with the E group. H2S and NO concentration of the HSH group were lower significantly than the HTS group and the HES group （P 〈 0.05）. TNF-α and MDA of the HSH group were lower and SOD were higher than the HTS group （P 〈 0.05）. But the HSH group and the HES group were almost sim

关 键 词：高渗氯化钠羟乙基淀粉40注射液 休克 脓毒性 复苏术 病理学 临床 小肠 硫化氢 一氧化氮 肿瘤坏死因子α 

分 类 号：R605[医药卫生—外科学] R971[医药卫生—临床医学]