CRRT联合参麦注射液对MODS犬的肾脏保护作用及可能机制  

The protective effect and possible mechanism of combined therapy of Shenmai injection and continuous renal replacement therapy on multiple organ dysfunction syndrome of dog

作　　者：于慧超[1] 马玉东[1] 

机构地区：[1]沈阳医学院附属中心医院重症医学科,辽宁沈阳110024

出　　处：《解剖科学进展》2015年第6期624-627,631,共5页Progress of Anatomical Sciences

基　　金：沈阳医学院青年科学研究基金(20132048)

摘　　要：目的观察连续性肾脏替代治疗(CRRT)联合参麦注射液(SMI)对多器官功能障碍(MODS)犬的肾脏保护作用并探讨其机制。方法采用失血性休克+复苏灌注+内毒素血症建立MODS模型,30只成年Mongrel犬随机分为多器官功能障碍组(M)、连续性肾脏替代治疗组(C)及连续性肾脏替代治疗联合参麦注射液组(C+S)。检测各组犬在不同时间点血清尿素氮(BUN)、肌酐(Cr)的含量,流式细胞仪检测单核细胞DLADR水平的动态变化,苏木精-伊红染色观察肾组织形态,透射电镜观察肾超微结构变化。结果 M组犬血清BUN、Cr含量明显升高正常犬(<0.01),C组及C+S组显著低于同时间点M组(<0.05);治疗2d后,C+S组血清BUN、Cr水平显著低于C组(<0.05)。M组犬外周血单核细胞计数及DLA-DR阳性单核细胞百分数显著低于正常犬(<0.01),而C组及C+S组显著高于M组(<0.05),联合治疗组治疗第3d和第4d后显著高于单纯应用CRRT组(<0.01或<0.05)。MODS犬肾小球充血,足突融合,肾小管浊肿,细胞器损伤,而CRRT组肾组织损伤明显减轻,CRRT+SMI组肾组织损伤最轻。结论连续性肾脏替代治疗能减轻MODS犬的肾脏组织损伤,参麦注射液可增强CRRT的疗效。Objective To investigate the protective effect and possible mechanism of combined therapy of Shenmai injection（SMI） and continuous renal replacement therapy（CRRT） on multiple organ dysfunction syndrome（MODS） of dog. Methods 30 Mongrel dogs were subjected to hemorrhagic shock plus resuscitation and endotoxemia to establish MODS model, and randomly divided into MODS group（M）, CRRT group（C）and CRRT＋SMI group（C＋S）. The serum levels of blood urea nitrogen（BUN） and creatinine（Cr） were detected. The expression of DLA-DR was detected by flow cytometry, renal morphological changes was observed by HE staining, renal ultrastructure was observed by transmission electron microscope. Results The serum levels of BUN and Cr are much higher in M group than in control（P〈 0.01）, but significantly lower in C or C＋S groups than in M group（ P〈0.05）, much lower in C＋S group than in CRRT group 2-days after treatment（P〈 0.05）. The monocytes number and the expression level of DLA-DR in monocytes were significantly decreased in M group than control group（P〈 0.01）, but increased in C group or C＋S group than in M group（ P〈0.05）, and higher in C＋S group thanin in C group 3 days or 4 days after treatment（P〈 0.05）. The glomerular congestion, foot process fusion, cloudy swelling of the tubular epithelial cells and organelles damages were found in kidney of M group, milder in C group than in M dogs, and much milder in C＋S group than in C group. Conclusion Continuous renal replacement therapy can reduce the damage of kidney tissue in MODS dogs, Shenmai injection could enhance the treatment effect.

关 键 词：连续性肾脏替代治疗 参麦注射液 多器官功能障碍综合症 犬白细胞抗原-DR 

分 类 号：R631[医药卫生—外科学]