三种液体复苏对重度失血性休克大鼠肝脏氧自由基的影响  

Effects of resuscitation with three kinds of fluid on liver oxygen free radical in rats with severe hemorrhagic shock

作　　者：陆化梅 魏利娟[2] 杨木强[2] 耿智隆[3] 赵峰[4] 

机构地区：[1]河南省正骨医院麻醉科,河南洛阳471000 [2]河南科技大学第一附属医院麻醉科,河南洛阳471000 [3]兰州军区兰州总医院麻醉科,兰州730050 [4]甘肃省人民医院麻醉科,兰州730050

出　　处：《解放军医学杂志》2012年第12期1111-1114,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨不同液体复苏对重度失血性休克大鼠肝脏氧自由基的影响及其可能的机制。方法 60只SD大鼠随机分为5组(n=12):对照组(C组)、乳酸林格液组(LR组)、6%羟乙基淀粉组(HES组)、7.2%高渗盐/6%羟乙基淀粉组(HSH组)、单纯休克组(SA组)。采用改良Wiggers法复制重度失血性休克动物模型,监测各组大鼠平均动脉压(MAP)变化。分别于休克前(Tb)、休克1h即刻(Ts)及复苏后4h(Td)取静脉血测丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)含量。SA组大鼠在Ts时间点处死取肝组织保存。LR、HES及HSH组分别以3倍失血量LR液、1倍失血量的HES液和6ml/kg的HSH液复苏。LR、HES、HSH及C组大鼠在Td时间点处死,取肝组织,采用免疫组化SP法检测TNF-α、NF-κB蛋白表达水平,比色法检测过氧化物歧化酶(SOD)活性和丙二醛(MDA)含量,ELISA双抗夹心法检测诱导型一氧化氮合酶(iNOS)含量,电镜及光镜下观察肝组织病理学变化。结果在复苏4h内HES维持MAP的稳定效果优于LR及HSH。与C组比较,其余各组血中AST及ALT明显升高(P<0.05),肝组织iNOS、NF-κB表达升高,MDA含量增加,SOD活性降低(P<0.05),肝组织病理学损伤明显;与SA组比较,LR、HES及HSH组上述指标表达升高,肝组织病理损伤明显。LR、HES及HSH组间比较,LR组上述指标升高最显著,肝组织病理损伤最重,而HSH组各指标表达减少,肝组织病理损伤较轻。结论 HSH能减少肝组织iNOS、NF-κB的产生,降低氧自由基引起的脂质过氧化反应,减轻失血性休克后肝组织损伤。Objective To explore effects of resuscitation with different kinds of fluid on liver oxygen free radical in rats with severe hemorrhagic shock. Methods Sixty SD Rats were randomly divided into 5 groups （n=12）： control group （C）, shock alone group （SA）, lactated Ringer＇s solution （LR）-treatment group, hydroxyethyl starch （HES）-treatment group, 7.2% hypertonic saline-6% HES （HSH）-treated group. According to Wigger＇s method, the rat model of severe hemorrhagic shock was reproduced. The mean arterial pressure （MAP） was monitored in all the 5 groups. The ALT and AST level in venous blood were determined before shock （Tb）, lh after shock （Ts） and 4h after resuscitation （Td） respectively. In SA group, the rats were sacrificed and the livers were collected at Ts. The rats were resuscitated with LR （3 times the volume of shed blood）, HES （1 time the volume of shed blood） and HSH （6ml/kg） in LR, HES and HSH group respectively. The rats in groups C, LR, HES and HSH were sacrificed at Td to obtain the liver tissues. The expression of TNF-ot, NF-KB protein, MDA and SOD activities were determined by immunohistochemistry （SP） and chromatometry. The iNOS content was detected by ELISA. The livers were also observed under light microscope and electron microscope for pathological changes. Results Compared with group C, the AST and ALT levels in other groups were significantly higher, the expressions of NF-KB, iNOS and MDA in liver significantly increased, while SOD activity significantly decreased （P〈 0.05）. The signs of injury were remarkable. The content of cytokines was significantly increased in blood in 3 fluid resuscitation groups compared with group SA （P〈 0.05）, and signs of tissue injury were also significant. In 3 fluid resuscitation groups, the increase in cytokines was most remarkable in group LR （P〈 0.05）, and liver tissue injury was also most remarkable, while the cytokine levels were lower （P〈 0.05） and pathological changes were als

关 键 词：休克 出血性 复苏术 活性氧 

分 类 号：R605.971[医药卫生—急诊医学]