Sun L L, Ruff P, Austin B, Deb S, Martin B, Burris D, Rhee P
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
Shock. 1999 Jun;11(6):416-22.
This study evaluated the effect of resuscitation fluids on intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). Sprague-Dawley rats (n = 36) were subjected to a 27 mL/kg hemorrhage over 5 min followed by a 1 h shock and 1 h resuscitation. Animals groups included: 1) cannulation only (Sham); 2) hemorrhage only (NR); 3) resuscitation with 1:1 shed blood (Blood); 4) resuscitation with 3:1 lactated Ringer's (81 mL/kg, 3LR+); 5) no hemorrhage but infusion with 3:1 lactated Ringer's (3LR); and 6) resuscitation with .36:1 hypertonic saline (7.5%, 9.7 mL/kg, HTS). At the end of resuscitation, the spleen and lung were harvested for detection of adhesion molecule mRNA and protein by RT-PCR and immunostaining. ICAM-1 and VCAM-1 expression exhibited the following pattern: 3LR+ > HTS approximate to 3LR > Blood approximate to NR approximate to Sham. VCAM-1 mRNA in the lung of the 3LR+ group was 2 or more times more than the groups of Sham, NR, Blood, and 3LR (p < .05). ICAM-1 and VCAM-1 mRNA in the spleen was significantly increased in the 3LR+ group compared with the groups of Sham, NR, and Blood (p < .05). Animals in the 3LR+ group showed enhanced staining for ICAM-1 in the pulmonary microvessels and in the marginal and trabecular areas of the spleen. Pulmonary edema and inflammatory cell infiltration were observed only in the 3LR+ group. In summary, resuscitation with LR following hemorrhagic shock induced immediate up-regulation of ICAM-1 and VCAM-1, which was associated with tissue injury. Thus, the type of resuscitation fluid used affected resuscitation injury.
本研究评估了复苏液对细胞间黏附分子-1(ICAM-1)和血管细胞黏附分子-1(VCAM-1)的影响。将36只Sprague-Dawley大鼠在5分钟内进行27 mL/kg的出血,随后进行1小时的休克和1小时的复苏。动物分组包括:1)仅插管(假手术组);2)仅出血(未复苏组);3)用1:1失血进行复苏(血液组);4)用3:1乳酸林格氏液进行复苏(81 mL/kg,3LR+组);5)未出血但输注3:1乳酸林格氏液(3LR组);6)用0.36:1高渗盐水进行复苏(7.5%,9.7 mL/kg,HTS组)。在复苏结束时,采集脾脏和肺组织,通过逆转录聚合酶链反应(RT-PCR)和免疫染色检测黏附分子的mRNA和蛋白。ICAM-1和VCAM-1的表达呈现以下模式:3LR+组 > HTS组≈3LR组 > 血液组≈未复苏组≈假手术组。3LR+组肺组织中VCAM-1的mRNA比假手术组、未复苏组、血液组和3LR组高出2倍或更多(p < 0.05)。与假手术组、未复苏组和血液组相比,3LR+组脾脏中ICAM-1和VCAM-1的mRNA显著增加(p < 0.05)。3LR+组动物肺微血管以及脾脏边缘和小梁区域的ICAM-1染色增强。仅在3LR+组观察到肺水肿和炎性细胞浸润。总之,失血性休克后用乳酸林格氏液复苏可立即上调ICAM-1和VCAM-1,这与组织损伤有关。因此,所用复苏液的类型会影响复苏损伤。