Liu Fei, Ma Tao, Liu Zhi
Department of Emergency, The First Affiliated Hospital of China Medical University, Shenyang 110001, P.R. China.
Exp Ther Med. 2013 Apr;5(4):1067-1072. doi: 10.3892/etm.2013.969. Epub 2013 Feb 20.
The aim of this study was to examine the characteristics of lung, kidney and small intestine injury caused by early resuscitation from hemorrhagic shock (HS) and endotoxic shock (ES) when ventilating with different tidal volumes (Vts). The study also considered the determination of the appropriate Vt for use in mechanical ventilation (MV) during treatment for shock. Resuscitated rabbits were ventilated with varying Vts for 120 min following 60 min of HS or ES. The histopathology, ultrastructure and apoptotic index (AI) of the lung, kidney and small intestine were then measured. Organs from the high-Vt groups (VT=12-15 ml/kg) showed the highest pathological scores (PSs; P<0.05). For HS, the renal PS and AI of the HS-M group (Vt=8-10 ml/kg)were lower than those of the HS-L group (Vt=4-6 ml/kg) and the lung PS and AI of the HS-C (control) group were lower compared with those of the HS-M group. For ES, the lung PS of the ES-L group was lower compared with that of the ES-M group (Vt=8-10 ml/kg) and the lung AI of the ES-C (control) group was lower compared with that of the ES-L group (Vt=4-6 ml/kg). When ventilated with the same Vt, ES resulted in higher PSs in the lung and intestine and a lower renal PS (P<0.05) than HS. MV was not recommended for either shock type. When it was necessary for MV to be applied, low Vt (4-6 ml/kg) protected the lung in ES. Moderate Vt (8-10 ml/kg) may be relatively safe to use for HS.
本研究的目的是探讨在不同潮气量（Vt）通气情况下，失血性休克（HS）和内毒素休克（ES）早期复苏后导致的肺、肾和小肠损伤的特征。该研究还考虑了在休克治疗期间确定机械通气（MV）中合适的Vt。复苏后的兔子在经历60分钟的HS或ES后，用不同的Vt通气120分钟。然后测量肺、肾和小肠的组织病理学、超微结构和凋亡指数（AI）。高Vt组（VT = 12 - 15 ml/kg）的器官显示出最高的病理评分（PSs；P < 0.05）。对于HS，HS - M组（Vt = 8 - 10 ml/kg）的肾PS和AI低于HS - L组（Vt = 4 - 6 ml/kg），HS - C（对照）组的肺PS和AI低于HS - M组。对于ES，ES - L组（Vt = 4 - 6 ml/kg）的肺PS低于ES - M组（Vt = 8 - 10 ml/kg），ES - C（对照）组的肺AI低于ES - L组。当用相同的Vt通气时，与HS相比，ES导致肺和小肠的PS更高，肾PS更低（P < 0.05）。不建议对任何一种休克类型进行MV。当有必要进行MV时，低Vt（4 - 6 ml/kg）对ES中的肺有保护作用。中等Vt（8 - 10 ml/kg）用于HS可能相对安全。
