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[不同液体复苏方式对失血性休克大鼠内脏器官细胞凋亡的影响]

[Effects of different means of fluid resuscitation on apoptosis of visceral organs in rats with hemorrhagic shock].

作者信息

Lu Yuan-qiang, Cai Xiu-jun, Gu Lin-hui, Wang Qi, Bao De-guo

机构信息

The Sir Run Run Shaw Hospital Affiliated to Medical College, Zhejiang University, Hangzhou 310016, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2005 May 18;85(18):1252-6.

Abstract

OBJECTIVE

To observe the effects of different means of fluid resuscitation on apoptosis of visceral organs in rats with hemorrhagic shock.

METHODS

The tails of 8 male SD rats were cut to cause active bleeding. Blood was collected from the carotid arteries of another 24 male SD rats and heparinized, then the 24 rats were randomly divided into 3 equal groups: no fluid resuscitation group (NF group, carotid blood was collected as described above, the tail was cut and the blood from the tail was collected in container with heparin 30 min after, and hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail), controlled fluid resuscitation group [NS40 group: isosmotic saline was infused during the period of 30 to 60 min after the tail cutting to maintain the mean arterial pressure (MAP) at about 40 mm Hg and then hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail], and great quantity fluid rapid resuscitation group [NS80 group: a great quantity of isosmotic saline was infused during the period of 30 to 60 min after the tail cutting to maintain the MAP at about 80 mm Hg and then hemostasis and heparin blood transfusion were performed 60 min after cutting of the tail]. Blood specimens were collected at the time points 0, 120, and 150 min to undergo blood routine examination. Another blood specimens were collected at the time points 0, 30, 60, and 90 min to undergo lactic acid examination. The surviving rats were killed and their livers, kidneys, lungs, and small intestines were taken out to undergo pathology. Cell apoptosis was examined by flow cytometry and TUNEL.

RESULTS

The survival rates of the NS40 and NS80 groups were significantly higher than that of the NF group (both P < 0.05). The blood lactic acid levels of the NS40 and NS80 groups at the time points 60 and 90 min were all significantly lower than those of the NF and control groups (all P < 0.05). Apoptosis in the liver, kidney, and small intestine mucosa of the NS80 group was significantly marked than in the NF and NS40 groups (all P < 0.01).

CONCLUSION

Controlled fluid resuscitation obviously reduces the early death rate of rats with severe hemorrhagic shock and apoptosis in the liver, kidney, and small intestine mucosa thereof and may benefit the prognosis.

摘要

目的

观察不同液体复苏方式对失血性休克大鼠内脏器官细胞凋亡的影响。

方法

将8只雄性SD大鼠尾巴切断造成主动出血。另取24只雄性SD大鼠,从其颈动脉取血并肝素化,然后将这24只大鼠随机分为3组,每组8只:未液体复苏组(NF组,按上述方法取颈动脉血,切断尾巴,30分钟后将尾巴血液收集于含肝素的容器中,60分钟后止血并进行肝素化输血)、控制性液体复苏组[NS40组:尾巴切断后30至60分钟内输注等渗盐水,维持平均动脉压(MAP)在40mmHg左右,60分钟后止血并进行肝素化输血]、大量液体快速复苏组[NS80组:尾巴切断后30至60分钟内输注大量等渗盐水,维持MAP在80mmHg左右,60分钟后止血并进行肝素化输血]。分别于0、120、150分钟时间点采集血标本进行血常规检查。另于0、30、60、90分钟时间点采集血标本进行乳酸检测。存活大鼠处死后取出肝脏、肾脏、肺脏和小肠进行病理检查。采用流式细胞术和TUNEL法检测细胞凋亡情况。

结果

NS40组和NS80组的存活率显著高于NF组(均P<0.05)。NS40组和NS80组在60、90分钟时间点的血乳酸水平均显著低于NF组和对照组(均P<0.05)。NS80组肝脏、肾脏及小肠黏膜的细胞凋亡明显高于NF组和NS40组(均P<0.01)。

结论

控制性液体复苏明显降低重度失血性休克大鼠的早期死亡率及其肝脏、肾脏和小肠黏膜的细胞凋亡,可能改善预后。

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