沙漠干热环境中暑大鼠肾脏损伤性变化的研究  

A research in renal injury of heatstroke rats in dry-heat atmosphere of desert

作　　者：周仁鸥[1] 刘江伟[1] 张东[1] 钱若筠[1] 赵涛[1] 

机构地区：[1]兰州军区乌鲁木齐总医院肝胆外科,乌鲁木齐830000

出　　处：《中华急诊医学杂志》2014年第11期1228-1233,共6页Chinese Journal of Emergency Medicine

基　　金：军队临床高新技术重大项目（2010gxjs016）

摘　　要：目的 了解大鼠在沙漠干热环境中暑状态下肾损害的变化特点,为临床救治提供理论依据.方法 48只大鼠,麻醉后随机（随机数字法）分成6组：轻度沙漠干热环境中暑组及其对照组,中度沙漠干热环境中暑组及其对照组,重度沙漠干热环境中暑组及其对照组.参照沙漠干热环境大鼠中暑模型,将各干热环境中暑组持续置于沙漠干热环境（41℃,10％湿度）下,各对照组持续置于常温环境（25℃,35％湿度）下,在各组大鼠的不同中暑阶段,取肾组织、肌组织行病理学检测,取腹主动脉血行肌酸激酶（creatine kinase,CK）、肌酐（creatinine,CREAT）、尿素（urea）、尿酸（uric acid,UA）检测.结果 病理学检测发现,在沙漠干热环境中暑时肾组织呈现出血管的扩张充血、血栓形成、出血、蛋白管型、内皮细胞损伤等,轻度中暑阶段以血管扩张充血为主,中度中暑阶段以血栓形成较明显,重度中暑阶段以出血及蛋白管型较明显;肌组织出现肌溶解,以重度阶段明显;各血液指标在三个中暑阶段的演变中,差异均具有统计学意义（CK：F=136.204,P=0.000; CREAT：F=172.865,P=0.000; UA：F=546.454,P=0.000; urea：F=73.823,P=0.000）;尚不能认为尿酸（UA）在轻度中暑阶段与其对照组的差异具有统计学意义（t=1.943,P=0.072）,其余指标各阶段中暑组与对照组的差异均具有统计学意义（P=0.000）.结论 沙漠干热环境中暑大鼠的肾脏损伤随着中暑过程的演变而加重,提示抢救沙漠干热环境中暑患者,应该警惕弥漫性血管内凝血（DIC）、肌溶解、急性肾衰竭的出现;同时严密监测血液生化指标并积极处理.Objective To observe the function of kidney compromised and histopathological changes of renal tissue in heatstroke rats under the dry-heat atmosphere of desert in order to find the mechanism for provide a rationale of clinical treatment.Methods Forty-eight anaesthetized rats were divided into six groups （n =8 in each group）：mild heatstroke group with its control group,moderate heatstroke group with its control group,and severe heatstroke group with its control group.The rats of three heatstroke groups were placed in a dry-heat environment prolonged with 41 ℃ and 10% humidity,and the three control groups were placed in a room temperature prolonged with 25 ℃ and 35% humidity.At heatstroke status of each group,arterial blood samples were collected from each group for testing creatine kinase （CK）,creatinine （CREAT）,uric acid （UA） and urea,kidney tissues and muscle tissues were taken for pathological examinations.Results Pathological examination showed dilatation and congestion of vessels,thrombosis,bleeding,protein casts and endothelium injury were found in the heatstroke rats.In mild heatstroke,the pathological changes mainly manifested as dilatation and congestion of vessels ; in moderate one,the changes mainly manifested as thrombosis; and in severe one,changes mainly manifested as bleeding and protein casts.Muscle tissues presented rhabdomyolysis,especially in severe one.The differences in biomarkers between three different degrees of heatstroke showed statistical significance （CK：F =136.204,P =0.000;CREAT：F =172.865,P=0.000; UA：F=546.454,P=0.000; urea：F=73.823,P=0.000）.There was no significant difference in UA between mild heatstroke group and its control group （t =1.943 ;P =0.072）,and the differences in rest biomarkers showed statistical significance between each heatstroke group and its control group （P =0.000）.Conclusions The kidney injury developed during heatstroke in dry-heat environment of desert suggests that we should be alert to disseminated intravascular coag

关 键 词：中暑 模型 沙漠 干热环境 肾损害 肾功能衰竭 

分 类 号：R594.12[医药卫生—内科学]