Department of Medicine, New York Medical College, Valhalla, NY, USA.
Shock. 2011 Nov;36(5):440-4. doi: 10.1097/SHK.0b013e3182336bda.
Fluid resuscitation is essential in the treatment of septic shock. This study examined the effect of resuscitative fluids (RFs) on sepsis-induced neutrophil-endothelial cell interactions. The RFs studied were 0.9% saline (NS), Ringer's lactate (RL), 7.5% saline and dextran-70 (DHS), 5% albumin (AL), and 6% hydroxyethyl starch (HS). Platelets and neutrophils were obtained from normal volunteers, and plasma was obtained from patients with septic shock. Microslides coated with human umbilical endothelial vein cell (HUVEC) and platelet-neutrophil solutions were primed with septic plasma with/without the RF. Neutrophil rolling velocity, leukoaggregation, and neutrophil adherence were determined. Separately, platelet-neutrophil solutions and endothelial cells were exposed to septic plasma with/without RFs, and cellular activation, neutrophil superoxide production, and endothelial cell E-selectin expression were assessed. Ringer's lactate decreased neutrophil rolling velocity and increased aggregation and adherence. Normal saline had no effect on these parameters. Hydroxyethyl starch and AL increased neutrophil rolling velocity and decreased adherence and aggregation when HUVECs were preincubated with the RF. Dextran-70 and 7.5% saline decreased neutrophil-endothelial cell interactions in both HUVECs and platelet/neutrophil preincubated experiments. Ringer's lactate increased activation of neutrophils and platelets, whereas AL decreased their activation. Other than NS, all the RFs increased neutrophil superoxide production. Ringer's lactate increased endothelial cell E-selectin release, whereas AL and HS both decreased its release. These data suggest that fluids used in the resuscitation of septic shock vary in their effects on sepsis-induced neutrophil-endothelial cell interactions. Ringer's lactate amplifies the effects of sepsis, while NS appears to have minimal impact. Dextran-70 and 7.5% saline, AL, and HS in varying degrees decrease sepsis-related neutrophil-endothelial cell interactions and activation.
液体复苏是治疗感染性休克的关键。本研究旨在探讨复苏液（RFs）对脓毒症诱导的中性粒细胞-内皮细胞相互作用的影响。研究的 RFs 包括 0.9%生理盐水（NS）、林格氏乳酸盐（RL）、7.5%生理盐水和右旋糖酐 70（DHS）、5%白蛋白（AL）和 6%羟乙基淀粉（HS）。血小板和中性粒细胞取自正常志愿者，血浆取自感染性休克患者。涂有人脐静脉内皮细胞（HUVEC）的微载玻片和血小板-中性粒细胞溶液用含有/不含有 RF 的感染性血浆预孵育。测定中性粒细胞滚动速度、白细胞聚集和中性粒细胞黏附。此外，血小板-中性粒细胞溶液和内皮细胞分别暴露于含有/不含有 RF 的感染性血浆中，评估细胞活化、中性粒细胞超氧化物产生和内皮细胞 E-选择素表达。林格氏乳酸盐降低中性粒细胞滚动速度，增加聚集和黏附。生理盐水对这些参数没有影响。当 HUVEC 用 RF 预孵育时，羟乙基淀粉和 AL 增加了中性粒细胞的滚动速度，并降低了黏附率和聚集率。Dextran-70 和 7.5%生理盐水降低了在 HUVEC 和血小板/中性粒细胞预孵育实验中中性粒细胞-内皮细胞的相互作用。林格氏乳酸盐增加了中性粒细胞和血小板的活化，而 AL 则降低了它们的活化。除 NS 外，所有 RF 均增加了中性粒细胞超氧化物的产生。林格氏乳酸盐增加了内皮细胞 E-选择素的释放，而 AL 和 HS 均降低了其释放。这些数据表明，在感染性休克复苏中使用的液体在其对脓毒症诱导的中性粒细胞-内皮细胞相互作用的影响方面存在差异。林格氏乳酸盐放大了脓毒症的作用，而 NS 似乎影响最小。Dextran-70 和 7.5%生理盐水、AL 和 HS 以不同程度降低了与脓毒症相关的中性粒细胞-内皮细胞相互作用和活化。
