不同液体复苏对失血性休克大鼠血浆TNF-α、IL-1及IL-6的影响

EFFECTS OF VARIOUS RESUSCITATION FLUIDS ON EXPRESSION PLASMA TNF-α、IL-1 AND IL-6 DURING TRAUMATIC SHOCK IN RATS

目的探讨大鼠创伤失血性休克复苏时使用6%羟乙基淀粉与乳酸林格氏液对早期肺损伤的影响及可能机制。方法45只SD大鼠随机分为3组,假手术(sham)组、乳酸林格氏液(RL)组和万汶(6%羟乙基淀粉,130/0.4,HES)组,每组15只。Sham组仅动静脉置管。RL组和HES组失血性休克后分别用乳酸林格氏液和6%羟乙基淀粉复苏,复苏2小时后取血测定血浆TNF-α、IL-1及IL-6,并处死动物取肺组织进行肺W/D比值测定和肺病理学检查。结果各实验组休克复苏2小时后血浆TNF-α、IL-1、IL-6以及肺W/D比值均较sham组高(p<0.05),光镜下肺病理损害严重;HES组复苏后维持MAP80～90mmHg所需液体较RL组明显减少(p<0.05);HES组血浆TNF-α、IL-1、IL-6水平及肺W/D比值均较RL组低(p<0.05);HES组肺病理损伤较RL组轻。结论大鼠创伤失血性休克后血浆TNF-α、IL-1、IL-6水平增高,并与肺损伤的严重程度密切相关。6%羟乙基淀粉复苏较乳酸林格氏液复苏能部分抑制炎症反应,减轻急性肺损伤。

Objective To investigate the changes of plasma TNF-α,IL-1 and IL-6 during traumatic shock in rats and therapeutic effects of Ringer＇s lactate and hydroxylethyl in traumatic shock in rats. Methods 45 rats were randomly divided into 3 groups： sham group （ no hemorrhage, and no resuscitation）, lactated Ringer＇s solution （ RL ） group and Hydroxylethyl starch （ HES ） group. RL group and HES group were subjected to traumatic shock for lh, followed by resuscitation to a controlled mean blood pressure with lactated Ringer＇ s solution and hydroxylethyl starch for 2 h. After resuscitation, plasma TNF-α,IL-1 and IL-6 were measured. The animals then were killed and lung tissues were sampled to measure values of wet-to-dry lung weight ratio （W/D ）. Results Compared with the sham group, plasma TNF-α,IL-1,IL-6 and W/D ratio were significantly higher in the RL and HES groups （p〈0. 05）. The volume of fluids required was significantly smaller in the HES group. Compared with the RL group, the HES group inhibited the expression of TNF-α,IL-1 and IL-6, and significantly decreased wet - to-dry lung weight ratio, and alleviated the pulmonary damage. Conclusion This study suggests that expression of plasma TNF-α,IL-1 and IL-6 are increased in traumatic shock in rats. Resuscitation with Hydroxylethyl starch can reduce lung tissue damage after traumatic shock, which caused, in part by down-regulation the expression of plasma TNF-α,IL-1 and IL-6.