不同液体小容量复苏对内毒素休克大鼠肾损伤及其NO和H_2S的影响  

Small Volume Resuscitation of Hypertonic Saline, Hydroxyethyl Starch and Hypertonic Saline Hydroxyethyl Starch Improve Renal Injury and Change H2S and NO Level in Experimental Endotoxin Shock in Rats: Comparison with 0.9% Saline

作　　者：罗晨芳[1] 高婉菱[1] 黎尚荣[1] 王艳玲[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：《中山大学学报（医学科学版）》2014年第1期32-37,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81178449)

摘　　要：【目的】探讨不同液体小容量复苏对大鼠内毒素休克肾损伤的影响,并观察肾皮质硫化氢和一氧化氮水平变化。【方法】清洁级SD大鼠30只,根据复苏所用液体种类随机分为5组,正常组(N组)、内毒素休克组(LPS,E组)、75 g/L高渗氯化钠组(LPS+HSS,HSS组)、羟乙基淀粉液130/0.4(万汶)组(LPS+HES,HES组)、高渗氯化钠羟乙基淀粉40溶液(霍姆)组(LPS+HSH,HSH组)。各组在静注LPS(1 mg/kg)30 min后予小容量复苏(4 mL/kg),测量不同时间点的血压;复苏60min后处死大鼠,取肾标本行病理学及干湿质量比检测,肾皮质匀浆测定一氧化氮(NO)和硫化氢(H2S)水平。【结果】①内毒素休克大鼠右颈总动脉收缩压进行性下降,予不同液体复苏后血压有不同程度回升,其中HSH效果最为明显;②内毒素休克大鼠肾切片病理观察发现肾小管局部坏死、肾小球足突融合、基底膜有沉积物,复苏组病理改变减轻,HSH组病变最轻;③各组大鼠肾干湿质量比未见有明显差异(P﹥0.05);④内毒素休克组肾皮质H2S浓度明显下降,NO水平明显升高(P<0.01),小容量复苏后,HES和HSH复苏组肾皮质H2S浓度明显升高,HSH组NO水平明显回落(P<0.05)。【结论】内毒素休克大鼠肾损伤明显,应用高渗盐水、羟乙基淀粉130/0.4溶液、高渗氯化钠羟乙基淀粉40溶液小容量复苏后肾脏病理改变减轻,肾皮质H2S水平升高、NO水平降低。[ Objective ] To evaluate influence of small-volume resuscitation with three different fluids on renal in endotoxemic rats. [Methods] 30 SD rats weighting 180-250 g were divided randomly into 5 groups （n = 6） ： Group N （LPS negative control group）, Group E （LPS ＋ 4 mL/kg physiologic saline ）, Group HSS （LPS＋ 4 mL/kg hypertonic saline solution）, Group HES （LPS ＋ 4 mL/kg hydroxyethyl starch）, Group HSH （LPS ＋ 4 mL/kg hypertonic sodium chloride hydroxyethyl starch）. Resuscitation was administrated 30 min after LPS injected. Systolic pressure of right common carotid artery were recorded at five time points ： preinjection of LPS, 30 min post-injection of LPS, 10 min post resuscitation, 30 min post resuscitation, 60 min post resuscitation. Then rats were executed and both kidneys were taken out. Renal pathological examination was observed under light microscope. Renal water content was observed. Nitricoxide （NO） and hydrogen sulfide （H2S） levels in renal cortex were measured. [Results] （1） Endotoxemia rats＇ systolic pressure of right common carotid artery dropped significantly, while it were obviously recovered in resuscitation group, especially in Group HSH; （2）Pathological change such as renal tubular necrosis, foot process fusion and basement membrane thickening was obvious in group E, while it was slightly in group HSS, HES, and HSH ; （3） There were no significantly difference in renal water content between all the five group; （4） The level of H2S in renal cortex was higher, while NO was lower in group E compared to group N （P 〈 0.05）. After small-volume resuscitation, H2S level increased in group HES and HSH （P 〈 0.05） and NO level decreased significantly in group HSH （P 〈 0.05）. [Conclusion] Renal pathological change occurs in endotoxemia rats. Smallvolume resuscitation with hypertonic saline solution, hydroxyethyl starch, and hypertonic sodium chloride hydroxyethyl starch could extenuate pathological changes, elevate H2S level and de

关 键 词：内毒素休克 小容量复苏 肾脏 一氧化氮 硫化氢 

分 类 号：R692[医药卫生—泌尿科学]