控制性低温对创伤失血性休克后早期炎症反应及器官功能的影响

Effects of controlled hypothermia on inflammatory reaction and organ function after traumatic hemorrhagic shock in rabbits

目的观察全身控制性低温对创伤失血性休克后早期全身炎症反应和器官功能的影响,探讨控制性低温在创伤失血性休克救治中的应用价值。方法健康新西兰大白兔24只,随机分为正常对照组(C组,n=6),常温组(Ⅰ组,n=6),浅低温组(Ⅱ组,n=6)和中低温组(Ⅲ组,n=6)。ELISA法测定血清TNFα,IL-1β、IL-6和IL-10浓度,比色法测定血浆转氨酶、尿素浓度。结果致伤后4、8小时,Ⅰ、Ⅱ、Ⅲ组血清TNFα、IL-1β、IL6、IL-10浓度与对照组相比均显著升高;Ⅱ组和Ⅲ组血清TNFα浓度显著低于Ⅰ组(P< 0．01);Ⅱ组IL-1β浓度显著低于Ⅰ组和Ⅲ组(P<0．01)。致伤后8小时,Ⅲ组血清IL-1β浓度显著低于Ⅰ组(P<0．01);致伤后4小时,Ⅱ组和Ⅲ组血清IL-6浓度显著低于Ⅰ组(P<0．01);Ⅱ组和Ⅲ组血清IL-10浓度分别在致伤后8、4小时显著高于Ⅰ组(P<0．01)。致伤后4、8小时,Ⅱ组和Ⅲ组血浆谷草转氨酶、谷丙转氨酶、尿素浓度均低于Ⅰ组。结论控制性低温可抑制创伤失血性休克后早期炎症反应,对肝肾功能也有一定的保护作用;浅低温对创伤后炎症反应的抑制作用优于中低温,且对生理功能影响更小,在创伤病人的临床救治中更具可行性。

Objectives To study the effects of controlled hypothermia on inflammatory reaction and organ function after traumatic hemorrhagic shock, so as to evaluate the value of application of controlled hypothermia in the field of trauma care. Methods Twenty-four healthy rabbits were randomly divided into 4 groups： controlled group （ group C, n = 6 ）, normal temperature shock group （ group Ⅰ , n = 6 ）, mild hypothermia shock group （ group Ⅱ , n = 6） ,moderate hypothermia shock group （groupm ,n =6）. The serum contents of tumor necrosis factor α（TNFα1, interleukin-1β ,6 ,10 （ IL-1β,6,10 ） were assayed with ELISA. The plasma contents of aminotransferase and urea were assayed with colorimetry. Results The serum contents of TNFα, IL-1β, IL-6 and IL-10 in the group Ⅰ , Ⅱ, Ⅲwere increased significantly after shock as compared with the group C. TNFα contents in the group Ⅱand Ⅲwere significantly lower as compared with the group Ⅰ on 4,8h after shock. IL-1β contents in the group Ⅱ were significantly lower than that of the group Ⅰand Ⅲ on 4,8h. The IL-1β contents in the group Ⅲ were significantly lower as compared with the group Ⅰon 8h after shock. The IL-6 contents in the group Ⅱand Ⅲwere significantly lower compared with the group Ⅰ on 4 after shock. The IL-10 contents in the group Ⅱand Ⅲ were significantly lower than that of the group Ⅰ on 8,4h after shock respectively. The plasma contents of GOT,GTP and urea in the group Ⅱand Ⅲwere lower than that of the group Ⅰ on 4,8h after shock. Conclusion Controlled hypothermia can strikingly inhibit inflammatory reaction and protect liver and renal function after traumatic hemorrhagic shock. The effects of mild hypothermia on inhibiting inflammatory reaction and protecting organ function were more potent as compared with moderate hypothermia, which may be superior to moderate hypothermia in the fields of traumatic shock care.