摘要：
目的 探讨不同浓度高渗钠盐溶液(HS)对严重烫伤大鼠早期肠损伤的影响.方法 按随机数字表法将104只健康雌性SD大鼠分为假伤组(n=8)、乳酸林格液(LR)组(n=24)及200、300、400 mmol/L HS组(HS200组、HS300组、HS400组,均n=24).LR组和不同浓度HS组于大鼠30%总体表面积(TBSA)Ⅲ度烫伤后即刻,分别经尾静脉输注LR或相应浓度HS进行液体复苏,并于补液2、8、24 h各处死8只大鼠取腹主动脉血及肠组织;假伤组大鼠模拟烫伤后直接处死取标本.采用全自动生化分析仪检测血Na+浓度;采用酶联免疫吸附试验(ELISA)检测血中肿瘤坏死因子-α(TNF-α)和白细胞介素-1β(IL-1β)含量;测定肠组织湿/干重(W/D)比值,反映肠含水量;应用紫外分光光度计测定肠组织丙二醛(MDA)含量和二胺氧化酶(DAO)活性;采用免疫组化法检测肠组织血管性血友病因子(vWF)的活化程度.结果 与假伤组比较,LR组和3个HS组伤后各时间点血中TNF-α、IL-1β含量及肠W/D比值、MDA含量均不同程度升高,肠DAO活性明显下降;血Na+浓度在LR组较假伤组明显降低,在3个HS组较假伤组明显升高,以伤后8 h变化较明显.与LR组比较,不同浓度HS组伤后各时间点血Na+浓度和肠DAO活性均升高,血TNF-α、IL-1β含量及肠W/D比值、MDA含量均降低,并呈一定剂量依赖性,以HS400组改变最显著,伤后8 h与LR组比较差异均有统计学意义〔血Na+(mmol/L):145.51±0.72比131.52±0.85,肠DAO(U/g):4.85±0.30比3.50±0.45,血TNF-α(ng/L):88.47±4.91比153.21±13.45,血 IL-1β(ng/L):85.77±3.42比140.57±10.46,肠 W/D 比 值:3.32±0.05比3.73±0.09,肠MDA(nmol/mg):0.58±0.01比0.82±0.04,均P<0.05〕.免疫组化结果显示,与假伤组比较,LR组和不同浓度HS组肠组织vWF活性均明显降低;与LR组比较,不同浓度HS组各时间点肠组织vWF活性均不同程度增强,并呈一定剂量依赖性,以HS400组阳性染色最深,提示400 mmol/L的HS补液后肠组织vWF活性最强.结论 与LR比较,HS复苏液能明显减轻严重烫伤大鼠伤后早期肠组织损伤,以400 mmol/L的HS效果最好.%Objective To investigate the effect of different concentrations of hypertonic saline solution (HS) on intestine injury in rats at the early stage of severe burn. Methods 104 adult healthy female Sprague-Dawley (SD) rats were randomly divided into five groups: sham group (n = 8), lactated Ringer solution (LR) group (n = 24) and 200, 300, 400 mmol/L HS group (HS200 group, HS300 group, HS400 group, all n = 24). All the rats in LR group and different concentrations of HS groups were scalded for 30% total body surface area (TBSA) with Ⅲ degree, after immediately, the rats were given burn resuscitation therapy by LR or corresponding concentrations of HS through the tail vein. Eight rats were sacrificed on the 2nd, 8th and 24th post-injury hour (PIH), respectively, to collect abdominal aorta blood and intestinal tissues. The rats in sham group were given simulation of burns without resuscitation, which were immediately sacrificed and the specimens were harvested. The serum Na+concentration was determined by automatic biochemical analyzer. Tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) contents in serum were determined by enzyme-linked immunosorbent assay (ELISA). The moisture content of intestine reflected by intestine wet/dry weight (W/D) ratio was determined. The content of malondialdehyde (MDA) and the activity of diamine oxidase (DAO) in intestinal tissue were determined by ultraviolet spectrophotometer. The activation of von Willebrand factor (vWF) was assessed by using immunohistochemistry. Results Compared with sham group, and the contents of TNF-α and IL-1β in blood and W/D ratio and MDA contents in intestine at each time point after injury in LR group and three HS groups were significantly increased, and the activity of intestinal DAO was significantly decreased. The serum Na+concentration was significantly reduced in the LR group as compared with that in the sham group, which was significantly higher in the three HS groups than that in the sham group, with the most obvious change on the 8th PIH. Compared with LR group, the serum Na+concentration and the activity of intestine DAO at each time point after injury in different concentrations of HS groups were significantly increased, and the serum contents of TNF-α, IL-1β and the W/D ratio, MDA contents in intestine were significantly lowered showing a dose dependent. The changes of HS400 group was the most significantly, and the difference on the 8th PIH was statistically significant as compared with LR group [blood Na+(mmol/L): 145.51±0.72 vs. 131.52±0.85, intestinal DAO (U/g): 4.85±0.30 vs. 3.50±0.45, blood TNF-α (ng/L):88.47±4.91 vs. 153.21±13.45, blood IL-1β (ng/L): 85.77±3.42 vs. 140.57±10.46, intestinal W/D ratio: 3.32±0.05 vs. 3.73±0.09, intestinal MDA (nmol/mg): 0.58±0.01 vs. 0.82±0.04, all P < 0.05]. The immunohistochemical results showed that the vWF activity in the LR group and different concentrations of HS groups was significantly reduced as compared with that of the sham group. Compared with LR group, the activity of intestinal vWF at each time point in different concentration of HS groups was increased to some extent with a dose dependent. The positive staining in HS400 group was the deepest, which showed that the activity of intestinal vWF was the strongest after treated by 400 mmol/L HS. Conclusion Compared with LR, HS can attenuate intestinal tissue injury of rats at the early stage of severely burned, and of all, the curative effect of 400 mmol/L HS is the best.
