Jiang Lin-Lin, Zhang Jing-Jing, Zhang Zong-Ze, He Xiang-Hu, Chen Dong-Ling, Wang Yan-Lin
Department of Anesthesiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Shock. 2016 Apr;45(4):441-9. doi: 10.1097/SHK.0000000000000515.
To determine the effects of intraperitoneal resuscitation (PR) with different concentrations of sodium pyruvate (PY) on intestinal ischemia reperfusion injury in rats hemorrhagic shock (HS).
Sixty rats were randomly assigned to six groups. These included: group SHAM, intravenous resuscitation only (VR) group, and four PR groups based on resuscitation fluid: glucose-lactate-based peritoneal dialysis solution (LA), and PY-1.1%, PY-1.6%, and PY-2.2% (concentrations in grams/dL). Mean arterial pressure (MAP) was monitored continuously. Blood pH, base excess (BE), lactate, intestinal myeloperoxidase (MPO), malondialdehyde (MDA), tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), activated caspase-3, and zonula occludens-1 (ZO-1) were measured; intestinal mucosal damage index (IMDI) and subcellular changes were observed; apoptotic index (AI) was calculated.
Three hours after resuscitation, in PY groups, MPO, MDA, IMDI, AI, TNF-alpha, and IL-6 were significantly lower than VR and LA groups, while pH and BE were higher. PY groups showed less expression of activated caspase-3 but elevated ZO-1. Among PY groups, group PY-1.1% had the lowest MPO, MDA and TNF-alpha, and had less pathological damage and subcellular changes than other experimental groups.
PR using PY solution combined with VR provided protection against intestinal ischemia-reperfusion injury following HS and resuscitation. Under the same hypertonic condition, 1.1% PY solution showed significant advantages compared with 2.2% and 1.6% solutions. The underlying mechanisms may include the maintenance of hemodynamic stability, regulation of homeostasis, inhibition of oxidative stress and inflammation, and protection of intestinal epithelial tight junction barrier function.
确定不同浓度丙酮酸钠（PY）腹腔复苏（PR）对大鼠失血性休克（HS）肠缺血再灌注损伤的影响。
将60只大鼠随机分为6组。这些组包括：假手术组、单纯静脉复苏（VR）组，以及基于复苏液的4个PR组：葡萄糖 - 乳酸盐腹膜透析液（LA）组，以及PY - 1.1%、PY - 1.6%和PY - 2.2%（浓度以克/分升计）组。持续监测平均动脉压（MAP）。测量血pH值、碱剩余（BE）、乳酸、肠髓过氧化物酶（MPO）、丙二醛（MDA）、肿瘤坏死因子α（TNF - α）、白细胞介素 - 6（IL - 6）、活化的半胱天冬酶 - 3和紧密连接蛋白 - 1（ZO - 1）；观察肠黏膜损伤指数（IMDI）和亚细胞变化；计算凋亡指数（AI）。
复苏3小时后，PY各浓度组的MPO、MDA、IMDI、AI、TNF - α和IL - 6均显著低于VR组和LA组，而pH值和BE值较高。PY各浓度组活化的半胱天冬酶 - 3表达较少，但ZO - 1升高。在PY各浓度组中，PY - 1.1%组的MPO、MDA和TNF - α最低，与其他实验组相比，病理损伤和亚细胞变化较少。
使用PY溶液联合VR进行PR可预防HS及复苏后肠缺血再灌注损伤。在相同高渗条件下，1.1% PY溶液与2.2%和1.6%溶液相比具有显著优势。其潜在机制可能包括维持血流动力学稳定性、调节内环境稳态、抑制氧化应激和炎症，以及保护肠上皮紧密连接屏障功能。
