不同复苏液对创伤性休克血浆TNF-α、IL-6的影响

摘要

目的 探讨创伤性休克患者使用不同复苏液对早期肺损伤的影响及可能机制.方法 120例创伤性休克患者随机分为3组:乳酸林格液组(LRH组)、25%白蛋白组(ALB组)、万汶组(VOLUVEN组),每组40例患者,记录3组复苏液的用量,并于复苏后2 h测血浆中TNF-α、IL-6表达水平.结果 复苏后维持MAP 80-90 mmHg时ALB组、VOLUVEN组复苏液量较LRH组明显减少(P<0.05);ALB组、VOLUVEN组复苏2 h后血浆TNF-d、IL-6表达水平均较LRH组低,差异有统计学意义(P<0.05).结论 创伤失血性休克时采用晶体液/胶体液联合治疗方案,复苏质量明显优于单纯使用晶体液;并且能降低血浆TNF-α、IL-6水平,减轻肺组织损伤.%Objective To investigate therapeutic effects of various resuscitation fluids and the changes of plasma TNFα and IL -6 during traumatic shock. Methods 120 patients with traumatic shock were divided into three groups (Ringer's lactated solution,25％ human albumin injection ,and voluven)randomly,40 each. The volumes of resuscitation fluids were recorded in the three groups after resuscitation to a controlled mean blood pressure . After resuscitation for 2 h, plasma TNFα and IL - 6 were measured. Results The volumes of fluids required were significantly smaller in ALB and voluven groups than the RLS group ( P ＜ 0.05 ). Plasma concentrations of TNFα and IL - 6, were significantly lower in ALB and voluven groups, compared with the RLS group ( P ＜ 0.05 ). Conclusions Resuscitation effects are better with crystalline and colloidal fluids than that only with crystalline fluid. Expressions of plasma TNFα and IL -6 are decreased more markedly in ALB and voluven groups than those in the RLS group in traumatic shock . Resuscitation with 25％ albumin and voluven is instrumental in reducing lung injury after traumatic shock .