促甲状腺素释放激素与HSD伍用对高原失血性休克合并肺水肿大鼠的治疗作用  

Beneficial effect of thyrotropin releasing hormone in combination with HSD on hemorrhagic shock with pulmonary edema at high altitude in the rat

作　　者：胡德耀[1] 刘良明[1] 李萍[1] 刘建仓[1] 刘厚东[2] 何燕梅[2] 霍小萍[1] 田昆仑[1] 石泉贵[2] 肖南[1] 周学武[1] 

机构地区：[1]重庆第三军医大学大坪医院野战外科研究所,重庆400042 [2]成都军区西藏拉萨军区总医院,西藏拉萨850003

出　　处：《中国危重病急救医学》2003年第5期268-271,共4页Chinese Critical Care Medicine

基　　金：全军"十五"攻关课题基金资助项目 ( 0 1L- 0 6 5 )

摘　　要：目的 :研究促甲状腺素释放激素 ( TRH)与高渗氯化钠 /右旋糖酐 ( HSD)伍用对急进高原的大鼠失血性休克合并肺水肿的疗效。方法 :实验在海拔 3 76 0 m的西藏拉萨市进行 ,急进高原大鼠 49只 ,从股动脉放血至平均动脉压 ( MAP) 5 0 mm Hg( 1m m Hg=0 .133k Pa) ,静脉注射 5 0 μl/ kg油酸制造肺水肿 ,维持该血压 1h,复制失血性休克合并肺水肿模型。实验分为假手术对照组 (不放血、不给油酸 )、单纯休克组、休克合并肺水肿组、乳酸林格氏液 ( 4ml/ kg,L R)组、TRH ( 5 m g/ kg)组、HSD( 4ml/ kg)组和 TRH与 HSD合用组 ,每组 7只动物。观察给药后 15、30、6 0和 12 0 m in的血流动力学指标变化 ,30和 12 0 min的血气指标变化和 12 0 min肺、脑含水量变化。结果 :TRH及 HSD单用或伍用给药后 MAP升高 ,左心室内压 ( L VSP)、左心室内压最大变化速率 (± dp/ dt m ax)改善 ,酸碱平衡紊乱缓解、肺湿重 /干重比减少 ,其中 TRH与 HSD伍用疗效在众多方面都比两药单用为优。结论 :TRH及 HSD单用及伍用对高原失血性休克合并肺水肿大鼠有良好的抗休克及减轻肺水肿的作用 ,其中两药伍用疗效更优。Objective:To study the effects of thyrotropinreleasing hormone(TRH) in combination with hypertonic saline/dextran(7.5% NaCl+6% Dextran 40,HSD) on hemorrhagic shock with pulmonary edema in the rats which were recently brought to high altitude.Methods:Fortynine SD rats,transported to Lasa, Tibet,which was 3 760 meters above the sea level,were anesthetized one week later with sodium pentobarbital (30 mg/kg,intraperitoneal).Hemorrhagic shock with pulmonary edema was induced by hemorrhage (50 mm Hg maintained for 1 hour,1 mm Hg=0.133 kPa) plus intravenous injection of oleic acid (50 μl/kg). They were equally divided into seven groups(n=7):normal control,hemorrhagic shock,hemorrhagic shock with pulmonary edema (HSPE),HSPE plus TRH(5 mg/kg),HSPE plus HSD( 4 ml/kg),and HEPE plus TRH and HSD in combination.Hemodynamic parameters including mean arterial blood pressure(MAP),left intraventricular systolic pressure (LVSP) and the maximal change rate of intraventricular pressure rise or decline (±dp/dt max) were observed at 15,30,60 and 120 minutes,blood gases were analyzed at 30 and 120 minutes,and the water content of lung and brain was determined at 120 minutes after drug administration. Results:TRH or HSD used alone or in combination significantly increased MAP,LVSP and ±dp/dt max( P<0.05 or P<0.01),ameliorated acidbase imbalance,and decreased the water content of lung and brain.The effect of the two in combination was superior to either drug used alone.Conclusion:TRH in combination with HSD can be used in the treatment of hemorrhagic shock with pulmonary edema at high altitude.

关 键 词：促甲状腺素释放激素 HSD 高原 失血性休克 大鼠 高渗氯化钠/右旋糖酐 肺水肿 疗效 合并症 

分 类 号：R605.591[医药卫生—外科学]