Schuerholz T, Sümpelmann R, Piepenbrock S, Leuwer M, Marx G
Department of Anaesthesia, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Br J Anaesth. 2004 May;92(5):716-21. doi: 10.1093/bja/aeh127. Epub 2004 Mar 19.
Sepsis is associated with volume deficit and clotting system activation. Platelet activation in sepsis results in an increased formation of microvesicles, which in turn, have been associated with increased mortality. We hypothesized an effect of different volume replacement solutions on platelet-derived microvesicle formation in septic shock.
Anaesthetized, mechanically ventilated and multi-catheterized pigs received 1 g kg(-1) body weight faeces into the abdominal cavity to induce sepsis and were observed over 8 h. Five animals in each group received volume replacement therapy with modified fluid gelatin 4% or 8% (MFG4%, MFG8%), 6% hydroxyethylstarch (HES) 200/0.5 or Ringer's solution (RS) to maintain a central venous pressure of 12 mm Hg. Flow cytometry was used for determination of microvesicles before induction of sepsis (baseline) and after 8 h. Platelets and microvesicles were identified with an anti-platelet monoclonal Ab and a secondary antibody. Microvesicles were determined as the smallest 1-3% positive cells in forward scatter. Intergroup comparisons were performed using Wilks-Lambda and Ryan-Einot-Gabriel-Welsh F-test. Differences within groups were compared using a two-tailed Student's t-test.
Baseline values were considered as 100%. While microvesicle formation was reduced in HES (73 (sd 19)%), MFG4% (63 (41)%) and MFG8% groups (53 (17)%), an increase in the RS-group (210 (121)%) was observed. Eight hours after induction of sepsis, formation of microvesicles was significantly higher in the RS group compared to all colloid-treated groups.
In this porcine septic shock model the formation of platelet-derived microvesicles was significantly increased by volume replacement with Ringer's solution in comparison to colloid solutions.
脓毒症与容量不足和凝血系统激活有关。脓毒症时血小板激活导致微泡形成增加，而微泡形成增加又与死亡率升高相关。我们推测不同的容量替代溶液对感染性休克中血小板衍生微泡形成有影响。
对麻醉、机械通气并多导管插管的猪，经腹腔给予1 g/kg体重的粪便以诱导脓毒症，并观察8小时。每组5只动物接受用4%或8%改良液体明胶（MFG4%、MFG8%）、6%羟乙基淀粉（HES）200/0.5或林格氏液（RS）进行容量替代治疗，以维持中心静脉压为12 mmHg。在诱导脓毒症前（基线）和8小时后，使用流式细胞术测定微泡。用抗血小板单克隆抗体和二抗鉴定血小板和微泡。微泡被确定为前向散射中最小的1 - 3%阳性细胞。组间比较采用威尔克斯-拉姆达检验和瑞安-伊诺特-加布里埃尔-威尔士F检验。组内差异采用双尾学生t检验进行比较。
基线值视为100%。虽然HES组（73（标准差19）%）、MFG4%组（63（41）%）和MFG8%组（53（17）%）的微泡形成减少，但RS组（210（121）%）观察到微泡形成增加。脓毒症诱导8小时后，RS组微泡形成明显高于所有胶体治疗组。
在该猪感染性休克模型中，与胶体溶液相比，用林格氏液进行容量替代显著增加了血小板衍生微泡的形成。
