不同输液量救治失血性休克的肝组织相关代谢机制  

Liver Tissue-related Metabolic Mechanism of Different Infusion Volumes for Hemorrhagic Shock

作　　者：李梦妮 胡智媚 庞源 吴思浔 张巧 苏锐冰 李纤纤 吴嘉燕 王典 于晓军 LI Meng-ni;HU Zhi-mei;PANG Yuan;WU Si-xun;ZHANG Qiao;SU Rui-bing;LI Qian-qian;WU Jia-yan;WANG Dian;YU Xiao-jun(Department of Forensic Pathology,Medical College,Shantou University,Shantou 515041,Guangdong Province,China)

机构地区：[1]汕头大学医学院法医学教研室,广东汕头515041

出　　处：《法医学杂志》2018年第6期625-630,634,共7页Journal of Forensic Medicine

基　　金：国家级大学生创新训练计划资助项目(201210560079;201610560033);"十二五"国家科技支撑计划子课题资助项目(2012BAK02B02);2018年度第三批医疗卫生科技计划项目(汕府科[2018] 155号);汕头大学医学院创新强校工程.重大项目培育计划NSFC青年基金培育资助项目(923-38040227)

摘　　要：目的探讨不同输液量救治失血性休克对肝组织相关代谢的影响。方法取30只家兔建立重度失血性休克模型,随机分为未输液组(A)、常量输液组(B)和过度输液组(C),每组10只,以常量输液组为对照,观察不输液和过度输液的危害。采用气相色谱-质谱法检测肝组织代谢物谱,分析3种不同情况与肝组织代谢变化的关系。结果过度输液组、未输液组的死亡率分别为70%和80%,常量输液组无死亡。过度输液组与常量输液组、未输液组的肝组织代谢轮廓差异有统计学意义。过度输液组肝组织代谢物中有21种低于常量输液组,8种低于未输液组。多种代谢物相对含量与输液量相关,琥珀酸含量与死亡相关(P<0.05)。结论常量输液救治失血性休克的疗效显著。过度输液肝组织代谢物普遍失代偿性降低,比未输液组家兔的存活时间长,可能是失血性休克后过度输液增加了血容量,组织液稀释是导致死亡的重要原因。Objective To investigate the curative effects of various infusion volumes on liver-related metabolic mechanism in the treatment of hemorrhagic shock.Methods A severe hemorrhagic shock rabbit model was established in 30 rabbits.The rabbits were randomly divided into three groups:non-infusion group(A),conventional infusion group(B),and excessive infusion group(C)(n=10 in each group).Taking group B as the control,groups A and C were observed for the damage of non-infusion and excessive infusion,respectively.The outcomes in the three groups and their relations with liver tissue metabolism changes were analyzed with gas chromatograph-mass spectrometer(GC-MS).Results The mortality in groups A,B,and C group were 80%,0%,and 70%,respectively.The liver tissue metabolic profile in group B showed statistically significant difference compared with that in groups A and B.In group C,the levels of 21 metabolites were lower than those in group B,and the levels of 8 metabolites were lower than those in group A.The relative contents of various metabolites were correlated with infusion volumes,and the succinic acid content was associated with death events(P<0.05).Conclusion The conventional infusion has significant curative effect on hemorrhagic shock.The metabolites of liver tissues with excessive infusion are generally decompensated and have longer survival time than those in non-infusion group,which may caused by the excessive infusion-induced blood volume increase after hemorrhagic shock.Tissue fluid dilution is an important cause of death.

关 键 词：法医病理学 失血性休克 肝 代谢 输液量 兔 

分 类 号：DF795.1[医药卫生—法医学]