经骨髓腔通路复苏失血性休克犬外周血中性粒细胞和血浆TNF-α及IL-4水平的变化

Mechanisms and production of plasma TNF-α and IL-4 in hemorrhagic shock canine resuscitated with intraosseous hypertonic saline solution

目的探讨经骨髓腔通路复苏失血性休克犬后外周血中性粒细胞(PMN)、血浆TNF-α和IL-4含量变化。方法健康雄性犬随机分为三组:7.5%氯化钠羟乙基淀粉40溶液组(HSH组)、生理盐水组(NS组)、假手术组(Sham组)。建立犬失血性休克模型,分别从胫骨骨髓腔输注HSH、NS两种复苏液,观察复苏后PMN、血浆TNF-α和IL-4含量的变化。结果失血性休克后,HSH组、NS组PMN数量均显著升高(P<0.05);复苏后各时点HSH组PMN数量持续升高,而NS组犬PMN数量呈降低趋势。休克后HSH组、NS组犬TNF-α、IL-4水平呈上升趋势;复苏后48h,HSH组犬TNF-α与相应时点Sham组相比差异无统计学意义(P>0.05);HSH组犬IL-4于复苏后48h显著高于相应时点NS组(P<0.05)。结论骨髓输注小剂量HSH(4ml/kg)是一种安全、有效的复苏方案;HSH具有抑制炎症反应,促进致炎和抗炎性反应平衡的作用。

Objective To investigate resuscitation effect and the production of polymorphonuclear neutrophils （PMN）,TNF-α and IL-4 with intraosseous hypertonic saline in hemorrhagic shock canine.Methods This study adopt Wiggers graded controlled hemorrhagic shock canine model,infusion low dose of 7.5% sodium chloride and 6% hydroxyethyl starch （HSH） and NS with tibia intraosseous access,monitor PMN density of peripheral blood during the phrase of hemorrhagic shock and resuscitation.The change of content of cytokines of TNF-α and IL-4 were measured with radioimmunity in hemorrhagic and resuscitation phrase.Results During hemorrhagic shock stage,the density of PMN in experiment groups significantly decreased as compared with Sham group （P〈0.05）.In resuscitation phase,the density of PMN in HSH group continuous increased tendency as compared with Sham group （P〈0.05）,however,downtrend occurred in NS group.During hemorrhagic shock stage,the content of TNF-α and IL-4 in experiment groups significantly increased as compared with Sham group （P〈0.05） and sustained high level during resuscitation phase.At time of 48 h resuscitation,the content of TNF-α in HSH group showed negative significant as compared with Sham group （P〉0.05）,and the content of IL-4 in HSH group significantly higher than NS group（P〈0.05）.Conclusions Intraosseous access techniques proved to be reliable means of alternative IV access.Low dose HSH resuscitation with intraosseous access is safety and effective fluid resuscitation concept.The infusion of HSH remarkably restricts inflammatory reaction,and modulates the balance of pro-and counter-inflammatory cytokine.