口服丙酮酸盐糖液对45%血容量失血性休克大鼠血流动力学和组织灌注的影响

Effects of oral rehydration with pyruvate-glucose-electrolyte solution on hemodynamics and tissue perfusion in resuscitation of hemorrhagic shock in rats with 45% blood volume loss

目的研究口服丙酮酸盐糖液对45%血容量失血性休克大鼠早期血流动力学及组织灌注的影响。方法选择雄性SD大鼠作为研究对象,进行胃造瘘置管和股动静脉插管处理,然后依据随机数字表法分为3组:休克不复苏组(NR组,n=20),休克口服丙酮酸盐糖液组(PGES组,n=20)和休克口服碳酸氢盐糖液组(BGES组,n=20)。以上3组按全身血容量的45%放血处理,每次5 min,间隔15 min。另选择10只大鼠在手术后不放血进行对照研究(NH组,n=10)。PGES组与BGES组于失血休克后0.5 h经胃造瘘管输入2倍失血量的丙酮酸盐糖液与碳酸氢盐糖液。在失血前、失血后即刻及失血后1、2、4 h各时间点测定各组的平均动脉压(MAP)及肝、肾、肠黏膜血流量相关指标,同时观察分析其失血后24 h内生存情况。对各数据进行F检验、t检验或Kruskal-Wallis秩和检验,生存率分析采用log-rank检验,P<0.05为差异有统计学意义。结果 NH组24 h内大鼠的存活率为100%,NR组、BGES组和PGES组失血后24 h大鼠的生存率分别为4.2%、20.8%和45.8%,组间比较差异均有统计学意义(P值均小于0.05)。观察发现各组失血性休克大鼠MAP及肝、肾、肠黏膜血流量在失血之后就开始进行性降低;NR组大鼠失血后1 h,MAP有一定幅度地上升,随后持续降低直至死亡;实验结果表明,和NR组相比,BGES组和PGES组大鼠失血后各时间点的MAP及各脏器血流量均有一定幅度的回升,且后者的回升幅度更大,差异均有统计学意义(P值均小于0.05)。结论口服丙酮酸盐糖液可显著改善45%血容量失血性休克大鼠的血流动力学及器官灌注指标,且效果优于碳酸氢盐糖液。丙酮酸盐糖口服液复苏可能对失血性休克的治疗提供一定的帮助作用。

Objective To study the effects of oral rehydration with glucose-electrolyte solution containing sodium pyruvate on early hemodynamics and tissue perfusion in hemorrhagic shock rats with 45%blood volume loss. Methods Male Sprague-Dawley( SD) rats underwent surgical catheter placements( at sites of stomach,left femoral artery and vein) were divided into three groups by means of random number table: hemorrhagic shock without rehydration( NR group, n = 20), hemorrhagic shock and oral administration of pyruvate-glucose-electrolyte solution( PGES group,n = 20),hemorrhagic shock and oral administration of bicarbonate-glucose-electrolyte solution( BGES group,n = 20). All rats in above three groups were bled about 45% total blood volume in 5 minutes twice with an interval of 15 minutes. Another10 rats without hemorrhage were followed by a control study( NH group,n = 10). Rats in PGES group and BGES group were fed with PGES or BGES at 0. 5 h after bleeding by twice of the blood loss volume. The mean arterial pressure( MAP) and organ( liver,kidney and intestinal mucosal) blood flow were measured before bleeding and at 0,1,2,4 h after bleeding,and the mortality within 24 hours was also analyzed. The data were analyzed by F test,t test or Kruskal-Wallis rank test,and the survival rate was analyzed by logrank test,there was statistical difference with P < 0. 05. Results All rats in NH group were alive at 24 h,and the survival rates within 24 h were 4. 2%,20. 8% and 45. 8% in the NR group,BGES group and PGES group respectively. There was significant difference between each two groups( with P values below 0. 05).The MAP and the organ blood flows were decreased continuously in the rats after bleeding. In NR group,the MAP rose to a certain extent at 1 h after hemorrhage,then consecutively decreasing until death. The experimental results also show that,compared with NR group,the MAP and organ blood flows in rats of BGES group and PGES group both had a certain degree of elevation at each timepoint after hemorrhage,both MAP and organ blood flows in the PGES group were significantly higher than that in the BGES group at 1,2,4 h after hemorrhagic shock,the differences were statistically significant( with P values below 0. 05).Conclusions Oral rehydration with glucose-electrolyte solution containing sodium pyruvate can significantly improve hemodynamics and organ perfusion in 45% blood volume hemorrhagic shock rats,and the effect is better than that of bicarbonate-containing oral rehydration solution. Oral rehydration with pyruvate-glucoseelectrolyte solution may play a certain role in the treatment of hemorrhagic shock.