轻度低温联合低压复苏对非控制出血性休克大鼠的保护作用及与线粒体功能改善的关系

摘要

Objective To investigate the protective effects of permissive hypothermia in combination with hypotensive resuscitation on treatment of rats with uncontrolled hemorrhagic shock and its mechanisms. Methods Anesthetized SD rats were used to make models of uncontrolled hemorrhagic shock( Phase Ⅰ). Uncontrolled hemorrhagic shock rats received normotensive (target MAP at 80 mmHg) or hypotensive resuscitation (target MAP at 50 mmHg) in combination with normal temperature(37℃ ) or hypothermia( 32℃ ) with lactated Ringer'g (LR) solution + hydroxylethyl starch (HES) at a ratio of 2:1 for 1 hour ( phase Ⅱ ). After complete hemostasis, rats then receivod definitive resuscitation with whole blood + LR solution for 2 hours ( phase Ⅲ). The blood loss, the amount of fluid infusion,the hematocrit (Hct) ,the hemodynamic parameters,the blood gases,animal survival and mitochondrial function and Na+ -K+ ATPase activity of liver,kidney and brain were observed. Results As compared with normothermiaormotensive,normothermia/hypoteusive and hypothermiaormotensive group, permissive hypotensive resuscitation in combination with hypothermia significantly decreased the blood loss, stabilized the hemodynamic parameters and kept the acid/base balance of shocked animals. The animal survival in hypothermic/hypotensive group (9/10,616min) was significantly superior to northermicormotensive group ( 1/10,256min) and hypothermicormotensive group (4/10,293min). And its mitochondrial function and Na+-K+ ATPase activity of liver,kidney and brain were better than other groups. Conclusion Permissive hypoteusive resuscitation in combination with hypothermia have good protective effect on uncontrolled hemorrhagic shock. Its mechanisms are related with improving organ mitochondrial function and Na+-K+ ATPase activity.%目的 观察轻度低温联合低压复苏对非控制出血性休克大鼠的保护作用及对线粒体功能的影响.方法 通过断脾复制非控制性出血性大鼠休克模型(时相Ⅰ),以乳酸林格液(LR)和羟乙基淀粉(HES)(体积比2:1)在37℃和32℃分别进行维持50mmHg 1小时的低压复苏和维持80mmHg 1小时的常压复苏(时相Ⅱ),彻底止血后用全血加LR(1:2)使平均动脉血压维持在90～100mmHg以上2小时(时相Ⅲ),观察大鼠的出血量、输液量、血流动力学指标、血气和动物存活率及线粒体呼吸功能,Na+-K+ ATP酶活性变化.结果 低压联合低温复苏能显著减少休克动物出血量,使血流动力学指标和血气维持在正常水平,同时显著改善休克大鼠肝肾肠线粒体功能和Na+-K+ ATP酶活性,其动物存活时间和存活数(616分钟,9/10)显著高于常温常压组(256分钟,1/10)和低压常温组(293分钟,4/10).结论 允许性低压联合低温复苏对非控制出血性休克大鼠有很好的保护作用,其机制与其改善重要器官线粒体功能和能量代谢功能有关.