体外膜肺氧合联合超滤复苏严重失血性休克兔减轻肾损伤  

Extracorporeal membrane oxygenation combined with ultrafiltration technique for treatment of kidney injury after severe hemorrhagic shock in rabbits

作　　者：田耕[1] 赵亮[1] 罗林[1] 肖娟[1] 刘梅[1] 唐富琴[1] 肖颖彬[1] 

机构地区：[1]第三军医大学附属新桥医院全军心血管外科研究所,重庆400037

出　　处：《中华创伤杂志》2014年第8期843-847,共5页Chinese Journal of Trauma

基　　金：军队临床高新技术重大资助项目（2010gxjs069）

摘　　要：目的 探讨体外膜肺氧合（extracorporeal membrane oxygenation,ECMO）联合超滤技术在严重失血性休克兔肾脏损伤中的意义. 方法 新西兰大白兔24只,建立压力控制型失血性休克模型,按随机数字表法分为休克未复苏组（未复苏组）、ECMO联合超滤技术复苏组（联合复苏组）、延迟液体复苏组（液体复苏组）,每组8只.心电监护检测心率,股动脉置管检测动脉血压.分别于休克前、休克后及复苏后采集血液标本,检测乳酸、血肌酐、IL-6及TNF-α水平.采集各组肾脏标本行HE染色,观察各组肾脏组织病理学改变;免疫组织化学染色,比较各组热休克蛋白70（heat shock protein 70,HSP70）在肾脏组织中的表达程度. 结果 联合复苏组的平均动脉压（53.1±1l.4）mmHg,较液体复苏组（41.3 ±11.1） mmHg和未复苏组（25.9±10.5） mmHg明显升高（F =41.425,P＜0.05）.乳酸、血肌酐、IL-6和TNF-α的水平,各组休克后较休克前均明显升高（P＜0.05）,液体复苏组较未复苏组均明显降低（P＜0.05）,联合复苏组较液体复苏组均明显降低（P＜0.05）.HE染色显示,联合复苏组肾脏组织坏死程度及炎症因子浸润程度均较液体复苏组明显减轻.HSP70的表达未复苏组中位数（四分位数）为17 828.960 0 （15 779.865 0～21 751.980 0）,液体复苏组为2 714.270 0（1 339.215 0 ～7 616.950 0）,联合复苏组为262.930 0（198.820 0～538.195 0）,三组间差异有统计学意义（P＜0.05）. 结论 与传统液体复苏比较,ECMO联合超滤技术在复苏严重失血性休克、改善组织缺氧性损害、减轻炎性反应等方面具有优势,并且能显著减轻肾脏组织的损伤.Objective To investigate the effect of extracorporeal membrane oxygenation （ECMO） combined with ultrafiltration in treatment of kidney injury induced by serious hemorrhagic shock in rabbits.Methods Models of pressure-controlled hemorrhagic shock was developed in 24 New Zealand white rabbits which were divided into unresuscitation group （n =8）,ECMO combined with ultrafiltration group （combined resuscitation group,n =8）,and fluid resuscitation group （n =8） according to the random number table.Heart rate was monitored via electrocardiograph and arterial pressure via fermoral artery catheter.Blood samples were collected pre-and post-shock and after resuscitation to measure levels of lactic acid,serum creatinine,IL-6,and TNF-α.Kidney samples were collected for measurement of histopathological changes via HE staining,expression of heat shock protein 70 （HSP70） via immunohistochemical staining.Results Arterial pressure was （53.1 ± 11.4） mmHg in combined resuscitation group,higher than （41.3 ± 11.1） mmHg in fluid resuscitation group and （25.9 ± 10.5） mmHg in unresuscitation group （F =41.425,P 〈 0.05）.Hemorrhagic shock induced significant up-regulation of lactic acid,serum creatinine,IL-6,and TNF-α（P 〈 0.05）,but all were lowered after resuscitation,especially in combined resuscitation group （P 〈 0.05）.HE staining showed the degree of kidney tissue necrosis and inflammatory cytokine infiltration in combined resuscitation group alleviated notably compared with fluid resuscitation group.Median and interquartile values of HSP70 were 17 828.960 0 （15 779.865 0-21 751.980 0） in unresuscitation group,2 714.270 0 （1 339.215 0-7 616.950 0） in fluid resuscitation group,and 262.930 0 （198.820 0-538.195 0） in combine resuscitation group,with statistical differences among groups（P 〈 0.05）.Conclusion ECMO combined with ultrafiltration is superior to conventional fluid resuscitation in improving hypoxia tissue injury and inflammatory reaction after hemorrhagic shoc

关 键 词：休克 出血性 体外膜氧合作用 超滤 

分 类 号：R459.7[医药卫生—急诊医学]