苹果酸林格液加温液体复苏改善严重创伤致死三联征的机制研究  

Mechanism of warmed malate ringer’s solution in fluid resuscitation in improving the lethal triad of severe trauma

作　　者：吴银雨 佘汉 杜云霞 张玉玺 周孝伟 李清晖 李涛[2] 胡弋[1] 毛庆祥[1] 王亚玲[3] WU Yinyu;SHE Han;DU Yunxia;ZHANG Yuxi;ZHOU Xiaowei;LI Qinghui;LI Tao;HU Yi;MAO Qingxiang;WANG Yaling(Department of Anesthesiology,Army Medical Center of PLA/Daping Hospital of Third Military Medical University,Chongqing,China;Department of War Wound Shock and Transfusion,Institute of Field Surgery,Army Medical Center of PLA/Daping Hospital of Third Military Medical University,Chongqing,China;Department of Nursing,Army Medical Center of PLA/Daping Hospital of Third Military Medical University,Chongqing,China)

机构地区：[1]陆军特色医学中心(第三军医大学大坪医院)麻醉科,重庆 [2]陆军特色医学中心(第三军医大学大坪医院)野战外科研究部战伤休克与输血研究室,重庆 [3]陆军特色医学中心(第三军医大学大坪医院)护理部,重庆

出　　处：《陆军军医大学学报》2025年第3期216-225,共10页Journal of Army Medical University

基　　金：国家自然科学基金青年科学项目(82300561);重庆市自然科学基金面上项目(CSTB2023NSCQ-MSX0713);重庆市科卫联合青年项目(2025QNXM038);重庆英才创新领军人才项目(CSTC2024YCJH-BGZXM0011);陆军军医大学科技创新能力提升专项项目(2023XLC11)。

摘　　要：目的探讨苹果酸林格液(malate ringer’s solution,MR)加温液体复苏改善严重创伤致死三联征的作用及机制。方法SPF级SD大鼠(雌雄各半,体质量200~220 g),采用多发伤联合失血性休克构建大鼠严重创伤模型,以随机数字表法将SD大鼠分为8组(n=8):假手术(Sham)组,仅动静脉置管;严重创伤(trauma,Tra)不同时间点(10、30、60、90、120、180 min)组以及严重创伤(Tra)组,分别于模型建立后不做任何处理观察180 min。通过血栓弹力图检测不同时间点各组大鼠活化凝血时间(activated clotting time,ACT)、凝血反应时间(reaction time,R)、血栓最大振幅(maximum amplitude,MA)、血凝块形成速率(Angle)指标变化,检测大鼠尾部出血时间变化、核心体温变化以及动脉血气相关指标改变情况。检测血浆血管性血友病因子(von Willebrand Factor,vWF)水平、肺静脉内皮线粒体呼吸控制率、血管内皮钙黏蛋白(vascular endothelial cadherin,VE-Cadherin)、过氧化物酶体增殖物激活受体γ共激活因子1α(peroxisome proliferator activating receptor gamma coactivator 1α,PGC1α)、线粒体动力相关蛋白1(dynamin-related protein 1,Drp1)、p-Drp1和线粒体融合蛋白(mitofusin 2,Mfn2)蛋白的表达水平,以评价血管内皮损伤和线粒体功能障碍情况。将SD大鼠按随机数字表法分为3组(n=8):严重创伤后180 min(Tra180 min)组,于创伤后180 min不做任何治疗;MR常温液体复苏(Tra180 min+MR)组,于创伤后60 min时使用医用输血输液加温器常温输注MR进行液体复苏;MR加温液体复苏(Tra180 min+MR+37℃)组,于创伤后60 min时使用医用输血输液加温器37℃加温输注MR进行液体复苏。观察及检测上述指标,以研究MR的复苏效果。结果与Sham组比较,严重创伤大鼠180 min时ACT和R值显著延长(P<0.05),MA和Angle值显著缩短(P<0.05),尾部出血时间显著延长(P<0.05),二氧化碳分压(partial pressure of carbon dioxide,PCO_(2))、HCO_(3)^(-)、剩余碱(base excess,BE)Objective To explore the role and mechanism of warm malate ringer’s solution(MR)in resuscitation of the lethal triad caused by severe trauma.Methods A rat model of severe trauma was established in SPF-grade SD rats(half male and half female,weighing 200~220 g)using combined multiple injuries and hemorrhagic shock,and the rats were randomly divided into 8 groups(n=8):Sham group,only arterial and venous catheterization;Trauma(Tra)groups with different time points(10,30,60,90,120,180 min)and a Trauma group that were observed without any treatment for 180 min after model establishment.The changes of activated clotting time(ACT),reaction time(R),maximum amplitude(MA),and rate of blood clot formation(Angle)at different time points were detected by using thromboelastography,and tail bleeding,core body temperature and arterial blood gas parameters,were also observed and detected.The plasma von Willebrand Factor(vWF)level,mitochondrial respiratory control ratio in pulmonary venous endothelium,and expression levels of vascular endothelial cadherin(VE-Cadherin),peroxisome proliferator activating receptor gamma coactivator 1α(PGC1α),dynamin-related protein 1(Drp1),p-Drp1,and mitofusin 2(Mfn2)were detected to evaluate the vascular endothelial injury and mitochondrial dysfunction.Another group of SD rats were randomly divided into severe trauma group(no treatment for 180 min after injury),and MR solution at room temperature and at 37℃groups.MR solution at room temperature or at 37℃was given to the rats using a medical blood transfusion apparatus at 60 min post-trauma.Above indicators were observed and detected to investigate the resuscitation effect of the MR solution.Results Compared with the Sham group,the severely traumatic rats at 180 min after injury had significantly prolonged ACT and R values(P<0.05),shortened MA and decreased Angle values(P<0.05),extended tail bleeding time(P<0.05),lower partial pressure of carbon dioxide(PCO_(2))and HCO_(3)^(-)and base excess(BE)levels(P<0.05),and continuously increasing K^(+)

关 键 词：创伤 苹果酸林格液 加温液体复苏 致死三联征 血管内皮细胞 

分 类 号：R641[医药卫生—外科学] R654.1[医药卫生—临床医学] R977.8