限制性液体复苏对创伤失血性休克大鼠全身炎性反应的影响：与非限制性液体复苏法比较  

Effects of limited fluid resuscitation on systemic inflammatory responses in rats with traumatic hemorrhagic shock： a comparison with unlimited fluid resuscitation

作　　者：谢俊然[1] 胡旭明[2] 赵锦宁[1] 鲍琪[1] 庞义娟[1] 吕然[1] 

机构地区：[1]310016杭州市,浙江大学医学院附属邵逸夫医院麻醉科 [2]徐州医学院麻醉学院

出　　处：《中华麻醉学杂志》2013年第9期1125-1130,共6页Chinese Journal of Anesthesiology

基　　金：浙江省自然科学基金（Y2110440）

摘　　要：目的 评价限制性液体复苏对创伤失血性休克大鼠全身炎性反应的影响.方法 健康清洁级雄性SD大鼠60只,2～3月龄,体重250 ～ 290 g,采用随机数字表法,将其分为6组（n=10）：假手术组（S组）、无液体复苏组（NF组）、非限制性液体复苏组（ULF组）、限制性晶体液复苏组（LR组）、不同限制性胶体液复苏组（LSG组和LHES组）.采用放血＋断尾法制备创伤未控制失血性休克模型.股动脉20 min内放血2.5 ml/100 g,放血结束后10 min断尾,同时行液体复苏,分别静脉输注乳酸钠林格氏液（ULF组和LR组）、4％琥珀酰明胶（LSG组）及6％羟乙基淀粉130/0.4（LHES组）.初始输注速率为2 ml·kg-1·min-1,限制性液体复苏目标MAP 50 mm Hg,非限制性液体复苏目标MAP 80 mm Hg.60 min后尾部断端止血并停止液体输注,改用血液复苏60 min后进入观察期180 min.于股动、静脉置管术后稳定10 min（T0）、股动脉放血结束后10 min（T1）、液体复苏结束（T2）、血液复苏结束（T3）及观察期结束（T4）时采集股动脉血样,测定Hct、血浆TNF-α、IL-6及IL-10的浓度；于T2时采集股动脉血样,检测单核细胞Toll样受体4（TLR4）及髓样细胞分化蛋白88（MyD88）表达水平和NF-κB活性；记录尾部断端出血量及输液量.另取SD大鼠120只,按照上述方法分组（n=20）和复苏处理后,观察72 h内生存情况.结果 与S组比较,其余各组Hct降低,血浆TNF-α、IL-6、IL-10浓度升高,单核细胞TLR4及MyD88表达上调,NF-κB活性增强（P＜0.05）.与NF组比较,ULF组、LR组及LSG组血浆TNF-α、IL-6浓度升高,IL-10浓度和Hct降低,单核细胞TLR4及MyD88表达上调,NF-κB活性增强,LHES组血浆TNF-α、IL-6浓度升高,IL-10浓度和Hct降低（P＜0.05）.与ULF组比较,LSG组、LHES组及LR组血浆TNF-α、IL-6浓度降低,IL-10浓度、Hct和生存率升高,单核细胞TLR4及MyD88表达下调,NF-κB活性减弱,尾部断端出血量降低,输液量减少�Objective To evaluate the effects of limited fluid resuscitation on systemic inflammatory responses in rats with traumatic hemorrhagic shock through comparing with unlimited fluid resuscitation.Methods Sixty pathogen-free male Sprague-Dawley rats,aged 2-3 months,weighing 250-290 g,were randomly divided into 6 groups （n =10 each） using a random number table：sham operation group （group S）,no fluid resuscitation group （group NF）,unlimited fluid resuscitation group （group ULF）,limited crystalloid fluid resuscitation group （group LR）,and limited colloid fluid resuscitation groups （group LSG and group LHES）.Traumatic uncontrolled hemorrhagic shock was induced by withdrawal of blood from the femoral artery at 2.5 mL/100 g over a 20-minute period,followed by tail amputation at 10 min after the end of blood withdrawal.At 10 min after the end of blood withdrawal,fluid resuscitation was performed.Lactated Ringer＇s solution （ULF and LR groups）,4 % succinylated gelatin （group LSG）,or 6 % hydroxyethyl starch 130/0.4 （group LHES） was infused intravenously.The initial infusion rate was 2 ml · kg-1 · min-1.The target MAP was maintained at 50 mm Hg in rats with limited fluid resuscitation,while at 80 mm Hg in rats with unlimited fluid resuscitation.After 60 min of fluid resuscitation,bleeding in the tail was stopped by ligation and fluid infusion was replaced with blood resuscitation.After 60 min of blood resuscitation,180 main of observation was started.At 10 min after catheterization of the femoral artery and vein （T0）,10 min after the end of blood withdrawal （T1）,the end of fluid resuscitation （T2）,the end of blood resuscitation （T3）,and the end of observation （T4）,arterial blood samples were collected to measure hematocrit （Hct）and concentrations of plasma tumor necrosis factor-alpha （TNF-α）,interleukin （IL）-6,and IL-10.Blood samples were collected from the femoral artery at T2 for determination of the expression of Toll-like receptor 4 （TLR4） and m

关 键 词：复苏术 休克 出血性 全身炎症反应综合征 

分 类 号：R459.7[医药卫生—急诊医学]