创伤性休克后血浆黏附分子的变化及不同复苏液的影响

The expression of plasma adhesion molecules after traumatic shock and influences of various resuscitation fluids

目的 探讨创伤性休克兔中性粒细胞黏附分子CD11b、血清可溶性细胞间黏附分子(sICAM ) 1的动态变化及不同复苏液的影响。方法 72只创伤性休克模型兔分为 6组 ,林格氏液组按失血量 2倍输入乳酸林格氏液 ,其他各组按 6ml/kg分别输入右旋糖酐 40、70 6代血浆、7.5 %氯化钠和 2 0 %白蛋白。分别采用流式细胞仪、酶联免疫吸附法检测CD11b、sICAM 1表达值。结果 各实验组休克 1hCD11b及sICAM 1表达增高 ,与对照组比较差异有显著性 (P <0 .0 5 ) ,并于12h达最高值 (林格氏液组 85 .6± 12 .1,60 9.3± 10 1.3 ;高渗盐组 77.5± 10 .3 ,5 18.5± 87.2 ;白蛋白组 78.2± 10 .7,5 2 2 .4± 88.3 ;P <0 .0 1)。高渗盐和白蛋白组 2 4、48hCD11b和sICAM 1分别为5 9 .2± 6.9,5 4.6± 5 .9;3 60 .1± 68.4,2 74.4± 40 .1;5 8.9± 6.4,5 5 .0± 5 .8;3 5 2 .6± 65 .3 ,2 70 .2±3 8.2 ,较林格氏液组 (72 .3± 10 .1,65 .8± 8.3 ;5 0 2 .6± 84.5 ,3 42 .4± 63 .1)降低 (P <0 .0 5 ) ;高渗盐和白蛋白组 (8.3 % )复苏 48h动物死亡率较林格氏液组 (4 1.7% )低 (P <0 .0 5 )。结论 创伤性休克时PMNCD11b和sICAM 1表达增加 ;采用 7.5 %氯化钠或 2 0 %白蛋白复苏时表达值及死亡率较乳酸林格氏液低。

Objective To investigate the changes of polymorphonuclear neutrophil adhesive molecule CD11b and serum soluble intercellular adhesion molecule 1 (sICAM 1) and influences of various resuscitation fluids in traumatic shock in rabbits.Methods Seventy two traumatic shock rabbits were divided into 6 groups.Lactated Ringer's (Two times of lost blood) was infused in Ringer's group,while Dextran 40,Hespan,7.5% HTS and 20% albumin were infused respectively in other groups with dosage of 6 ml/kg.CD11b and sICAM 1 were measured by flow cytometry and radioligand binding assay respectively.Results Both CD11b and sICAM 1 were increased significantly 1 h after traumatic shock in all experimental groups ( P < 0.05), and reached the peak at 12 h after shock (Ringer's 85.6± 12.1, 609.3± 101.3; 7.5% HTS 77.5± 10.3, 518.5± 87.2; 20% albumin 78.2± 10.7, 522.4± 88.3; P < 0.01). CD11b and sICAM 1 were significantly lower in groups of 7.5% HTS and 20% albumin at 24 and 48 h after trauma (59.2± 6.9, 54.6± 5.9; 360.1± 68.4, 274.4± 40.1; 58.9± 6.4, 55.0± 5.8; 352.6± 65.3, 270.2± 38.2 respectively) than in the LR group (72.3± 10.1, 65.8± 8.3; 502.6± 84.5,342.4± 63.1) ( P < 0.01). Animal death rate in groups of 7.5% HTS and 20% albumin (8.3%) was lower than in LR group (41.7%) ( P < 0.05). Conclusion The expression of PMN CD11b and sICAM 1 was increased in traumatic shock in rabbits.Among the studied fluids,20% albumin and 7.5% HTS could result in lower expression of CD11b and sICAM 1,and lower mortality than single use of Lactated Ringer's.