丙酮酸盐替代乳酸盐腹膜透析液腹腔复苏对失血性休克家兔肝脏功能的影响

摘要

Objective To observe the influence of direct peritoneal resuscitation on liver function in hemorrhagic shock rabbits with pyruvate peritoneal dialysis solution instead of lactate peritoneal dialysis solution. Methods 48 hemorrhagic shock rabbits were randomly divided into conventional intravenous resuscitation group (group A),intravenous resuscitation plus intraperitoneal injection of lactate peritoneal dialysis solution group (group B),intravenous resuscitation plus intraperitoneal injection of pyruvate peritoneal dialysis group(group C), intravenous pyruvate peritoneal dialysis resuscitation plus intraperitoneal injection of pyruvate peritoneal dialysis group(group D). The hemodynamic changes were observed and the AST and ALT were measured respectively before and 60 min after shock ,60 min and 180 min after resuscitation. The dry/wet weight ratio ,MDA and SOD of liver tissue were measured,and the liver morphological changes were observed. Results After the completion of shock resuscitation,MAP of all groups were almost restored to the basal level. 180 min after resuscitation,the MAP of animals in group A was lowered than that in group B,C and D(P<0.05). After shock,ALT and AST were signifi-cantly higher than those before shock ,but no significant difference was found between groups (P > 0.05). After resuscitation,ALT and AST continued to decline in all groups,but the decline range increased with the order of A, B,C,D group(P < 0.05). The water content and MDA in liver tissue decreased with the order of A,B,C,D group,while the SOD increased and the differences between groups were significant(P<0.05). And the degree of liver tissue morphological injury also relieved correspondingly. Conclusion Pyruvate substituting lactate peritoneal dialysis solution peritoneal resuscitation can be more effective in reducing liver damage of hemorrhagic shock rabbits.%目的 观察以丙酮酸盐替代乳酸盐腹膜透析液腹腔复苏对失血性休克家兔肝脏功能的影响.方法 48只失血性休克家兔随机分为常规静脉复苏组(A)、常规静脉复苏+腹腔注射乳酸盐腹膜透析液组(B)、常规静脉复苏+腹腔注射丙酮酸盐腹膜透析液组(C)和静脉丙酮酸盐液复苏+腹腔注射丙酮酸盐腹膜透析液组(D).观察血流动力学变化,测定休克前、休克后60 min及复苏后60和180 min的ALT、AST含量.复苏180 min后取肝组织测定干/湿重比、MDA和SOD,并观察形态学变化.结果 复苏后各组MAP都恢复至近基础水平,复苏180 min后A组MAP低于B、C、D三组(P<0.05).休克后,ALT、AST含量均较休克前明显升高,组间无差异(P>0.05);复苏后,ALT、AST持续性下降,下降的幅度随A、B、C、D组依次加大(P<0.05).肝组织含水量及MDA含量随A、B、C、D组依次降低,而SOD活力则依次升高(P<0.05),组织形态学损伤随之不断减轻.结论 丙酮酸盐替代乳酸盐腹膜透析液腹腔复苏可更有效减轻失血性休克家兔的肝脏损伤.