去白细胞血和红细胞-代血浆对犬失血性休克的疗效

Efficacy of leukocyte-depleted blood and plasma substitute mixed with RBCs in the treatment of hemorrhagic shock in dogs

目的评价去白细胞血和红细胞-代血浆对犬失血性休克的疗效及其机制。方法成年家犬24只,随机分为4组(n=6):代血浆组(A组)、全血组(B组)、去白细胞血组(C组)和红细胞-代血浆组(D组)。采用Wiggers改良法建立犬可逆性休克模型,放血使平均动脉压降至40 mmHg,并维持60min。各组以10ml·kg-1·min-1速率输注不同液体进行治疗。分别于休克前即刻(T1基础值)、休克60min(T2)和休克治疗后60 min(T3)监测血压(MAP)、心率(HR)、心输出量(CO),同时取静脉血检测血浆丙二醛(MDA)、白细胞介素-1β(IL-1β)、内皮素(ET)、肿瘤坏死因子-α(TNF-α)、血小板活化因子(PAF)以及中性粒细胞表面粘附分子CD11b的水平。结果与T1相比,T2时4组MAP、CO降低,HR增快,血浆MDA、IL-1β、ET、TNF-α、PAF及CD11b的水平均增高;与T2相比,T3时B组、C组、D组HR减慢,4组MAP均升高,血浆MDA、IL-1β、ET、TNF-α、PAF及CD11b水平均降低;与A组相比,B组血浆MDA、IL-1β、CD11b水平降低,C组MAP升高、CO增加,血浆IL-1β、ET及PAF水平降低,D组MAP升高、CO增加、HR减慢,血浆:MDA、IL-1β、ET、PAF及CD11b水平降低;与B组相比,C组和D组CO增加、血浆MDA、IL-1β、ET、PAF及CD11b的水平降低;与C组相比,D组PAF水平降低,其余各指标差异无统计学意义。结论去白细胞血及红细胞-代血浆对犬失血性休克具有良好的治疗效果,其机制与抑制全身炎性反应有关。

Objective To evaluate the efficacy of leukocyte-depleted blood and 6% hydroxyethyl starch （HES） mixed with RBCs in the treatment of hemorrhagic shock and their effects on the systemic inflammatory response. Methods Twenty-four healthy dogs of both sexes weighing 15-20 kg were randomized into 4 groups （ n = 6 each）： A HES; B whole blood; C leukocyte-depleted blood and D RBC-HES. Hemorrhagic shock was produced according to Wigger＇ s method. MAP was maintained at 40 mm Hg for 60 min by blood removal. Subsequently the dogs were resuscitated with 6% HES or whole blood or leukocyte-depleted blood or RBC-6% HES. MAP, HR and cardiac output （CO） were monitored and recorded. Venous blood samples were taken for determination of plasma concentrations of MDA, IL-1β, endothelin （ET）, TNF-α, platelet activating factor （PAF） and neutrophil CD11 b expression immediately before shock （T1, baseline） at the end of 60 min shock （T2 ） and at 60 min of resuscitation （T3） . Results MAP and CO were significantly decreased whereas HR was significantly increased during shock （T2） in all 4 groups. Plasma concentrations of MDA, IL-1β, TNF-α, ET, PAF and neutmphil CDllb expression were significantly increased during shock at T2 and returning to pre-shock baseline level during resuscitation at T3 in all 4 groups especially in group C and D. Conclusion Both leukocyte-depleted blood and RBC-HES mixture have satisfactory anti-hemorrhagic shock effect and can attenuate the systemic inflammatory response induced by hemorrhagic shock.