复方高渗盐溶液对脓毒症大鼠的治疗作用  

Effect of compound hypertonic saline solution on septic rats Dong Fang

作　　者：董芳 徐亮 徐刚 王华兵 陆辉志 蔡利萍 

机构地区：[1]武汉市第三医院重症医学科,湖北武汉430060 [2]武穴市第一人民医院重症医学科

出　　处：《中华危重病急救医学》2015年第1期54-58,共5页Chinese Critical Care Medicine

基　　金：湖北省武汉市医药卫生项目（WX10C15）

摘　　要：目的探讨复方高渗盐溶液（HSD）对脓毒症的治疗作用。方法雄性Wistar大鼠133只，按随机数字表法分为假手术组（n=15）、盲肠结扎穿孔术（CLP）组（n=45）、CLP＋生理盐水（NS）组（n=45）、CLP＋HSD组（n=28）4组。采用CLP方法制备脓毒症大鼠模型，假手术组除不结扎和穿刺盲肠外，其余手术步骤相同。4组大鼠术毕均皮下注射0．9％氯化钠30mUkg；CLP＋NS组、CLP＋HSD组分别于术后3h自颈静脉内输注0．9％氯化钠或7．5％氯化钠／6％右旋糖酐705mL／kg（0．4mL·kg^-1·min^-1）。各组于术后9h、18h观察大鼠生存率。术后0、9、18h监测平均动脉压（MAP），采用酶联免疫吸附试验（EALIS）检测血浆肿瘤坏死因子-α（TNF—α）、白细胞介素-1β（IL-1β）、降钙素原（PCT）的含量。术后18h处死大鼠，检测支气管肺泡灌洗液（BALF）中性粒细胞比例、肺组织髓过氧化物酶（MPO）活性，计算肺组织湿／干质量（W／D）比值，并观察肺组织病理学改变。结果假手术组动物未发生死亡，CLP组9h、18h生存率分别为62．2％、31．1％，CLP＋NS组分别为57．8％、35．6％，CLP＋HSD组分别为85．7％、64．3％；CLP＋HSD组生存率较CLP组及CLP＋NS组明显改善（P〈0．05或P〈0．01）。与假手术组比较，CLP组及CLP＋NS组术后MAP明显下降，血浆TNF-α、IL-1β、PCT水平明显升高；而CLP组与CLP＋NS组比较无差异。CLP＋HSD组术后9h、18h时MAP、血浆TNF—α、IL-1β、PCT水平较CLP＋NS组明显改善[MAP（mmHg，1mmHg=0.133kPa）9h：102±5比94±6，18h：90±2比72±3；TNF—α（ng/L）9h：284．19±57．18比329．67±45．79，18h：263．46±42．58比349．68±52．40；IL-1β（ng/L）9h：219．28±39．21比263．47±32．36，18h：195．98±39．06比250．10±41．57；PCT（μg/L）9h：2．32±0．37比4．52±0．75，18h：2．89±0．62比5．02±0．84；P〈0．05或P〈0．01]。术后18h，CLP组及CLP�Objective To study the effect of compound hypertonic saline solution （HSD） on sepsis. Methods 133 male Wistar rats were divided into four groups, sham operation group （n = 15 ）, cecal ligation and puncture （CLP） group （n = 45）, CLP plus normal saline （NS） group （n = 45）, and CLP plus HSD group （n = 28）. A rat model of sepsis was reproduced by CLP, and the rats in sham operation group received celiotomy without ligation and puncture. All rats in four groups received subcutaneous injection of 30 mL/kg 0.9% sodium chloride after laparotomy. The rats in CLP plus NS group and CLP plus HSD group received infusion of 5 mL/kg 0.9% sodium chloride or 7.5% sodium chloride/6% dextran post CLP via jugular vein for 3 hours, with the infusion rate of 0.4 mL·kg^-1·min^-1. The survival rate of each group was observed 9 hours and 18 hours after laparotomy. Mean arterial pressure （MAP） at 0, 9, 18 hours were monitored. Blood specimens were collected from all rats 0, 9 and 18 hours after laparotomy, respectively, for measurement of the plasma levels of tumor necrosis factor-α （TNF-α）, interleukin- 1β （ IL- 1β）, and procalcitonin （PCT）. The rats were all sacrificed, and their lung tissues were harvested for the neutrophil count in bronchoalveolar lavage fluid （BALF）, myeloperoxidase （MPO） activity in lung tissue, wet/dry weight ratio （W/D） of lung, and pathological changes in lung tissue. Results There was no death in the sham operation group. The survival rates at 9 hours and 18 hours were 62.2% and 31.1% in the CLP group, 57.8% and 35.6% in the CLP plus NS group, 85.7% and 64.3% in the CLP plus HSD group, and they were all significantly higher compared with those of the CLP group and the CLP plus NS group （P 〈 0.05 or P 〈 0.01 ）. MAP levels in the CLP group and the CLP plus NS group were significantly lower than those in sham operation group, and the plasma levels of TNF-α, IL-1β and PCT were significantly higher compared with those of sham operation group, wh

关 键 词：复方高渗盐溶液 脓毒症 盲肠结扎穿孔术 免疫功能 髓过氧化物酶 降钙素原 

分 类 号：R459.7[医药卫生—急诊医学]