不同液体复苏对重度失血性休克大鼠肝脏损伤的影响

摘要

目的:观察不同液体复苏对重度失血性休克大鼠肝脏损伤的影响.方法:60只SD大鼠随机分为5组:对照组(C组)、乳酸林格氏液组(LR组)、6％羟乙基淀粉组(HES组)、7.2％高渗盐/6％羟乙基淀粉组(HSH组)、单纯休克组(NR组),每组12只.采用改良Wiggers法复制重度失血性休克动物模型,监测各组大鼠无创血压(MAP)变化;分别于休克前、休克1h及复苏后4h取静脉血测谷丙转氨酶(ALT)及谷草转氨酶(AST)含量;NR组休克1h即刻处死大鼠取肝组织保存,LR、HES及HSH组分别以3倍失血量LR液、1倍失血量HES液和6 ml/kg HSH液复苏.LR、HES、HSH组及C组在复苏后4h处死大鼠,取肝组织检测肿瘤坏死因子-α(TNF-α)、核因子-κB (NF-κB)、诱导型一氧化氮合酶(iNOS)、巨噬细胞炎性蛋白2(MIP-2),丙二醛(MDA)的表达水平、超氧化物歧化酶(SOD)及结肠组织髓过氧化物酶(MPO)活性;电镜及光镜下观察肝组织病理变化.结果:失血性休克后,LR、HES及HSH组给予液体复苏后MAP均升高.与C组比较,NR、LR、HES及HSH组血浆AST及ALT明显升高(P＜0.05),肝组织TNF-α、NF-κB、iNOS及MIP-2的蛋白表达明显升高,MPO、MDA及SOD活性增加(P＜0.05),肝组织病理学损伤明显;与NR组比较,LR、HES、HSH组以上指标表达增加,肝组织病理损伤加重;与HES组比较,LR组以上指标表达增加最显著,肝组织病理损伤最重,而HSH组各指标表达减少,肝组织病理损伤最轻.结论:7.2％高渗盐/6％羟乙基淀粉能减少肝组织细胞因子产生,降低炎症反应及氧自由基引起的脂质过氧化反应,减轻失血性休克复苏后肝组织损伤.%Objective:To obeserve the effects of different fluids resuscitation on liver injury in rats with severe hemorrhagic shock.Methods:Sixty SD rats were randomly divided into 5 groups:control group(group C),LR treated group(group LR),HES treated group (group HES),HSH treated group(group HSH),shock group(group NR),twelve rats in each group.According to Wiggers method,the rat model of severe hemorrhagic shock was established.MAP was monitored.The level of ALT and AST were tested before the shock,1 h after shock,4 h after resuscitation by taking venous blood.1 h after shock in NR,the rats were killed and the livers were collected.The rats were resuscitated respectively with LR (3 times the volume of shed blood)、HES(1 times the volume of shed blood)and HSH (6 ml/kg).4 hour after resuscitation,the rats in C,LR,HES and HSH group were killed and the livers were collected to determine the expression of TNF-α,NF-κB,MIP-2,MDA,iNOS and activity of MPO,SOD.The pathologic injury of liver was observed by light microscope and electron microscope.Results:Compared with group C,the levels of AST and ALT in NR,LR,HES and HSH groups were significantly higher (P ＜0.05),the expression of NF-κB,TNF-α,MIP-2,iNOS,MDA and activity of MPO,SOD in liver were significantly increased (P ＜0.05),and pathologic injury was increased obiviously.Compared with NR group,the pathologic injury was also increased significant(P＜0.05).Compared with HES group,the cytokines and pathologic injury of LR group was increased significantly(P＜0.05),the cytokines and pathologic injury of HSH group was most lessened (P＜0.05).Conclusion:HSH resuscitation can attenuate the liver injury after severe hemorrhagic shock by decreasing cytokines production,reducing inflammatory reaction and oxygen free radical.