不同复苏液体对“二次打击”致多器官功能障碍综合征的影响

The influence of different fluid resuscitation on multiple organ dysfunction syndrome associated with hemorrhagic shock followed by resuscitation and endotoxin

目的：探讨不同复苏液体对＂失血性休克＋内毒素＂二次打击致大鼠多器官功能障碍综合征（MODS）的影响。方法：SD大鼠90只,随机分为正常对照组、乳酸林格液复苏组和高渗盐水复苏组3组,每组各30只。先采用通过颈动脉插管放血的方法复制大鼠失血性休克的动物模型,维持平均动脉压（MAP）在35～40mmHg1h后进行液体复苏,乳酸林格液复苏组用乳酸林格液复苏,高渗盐水复苏组用7.5%高渗盐水复苏。复苏成功后30min腹腔注入内毒素复制大鼠MODS模型,分别在注射内毒素后24h和36h取血和收集相关标本,观察各组大鼠主要器官功能指标、MODS发生率以及死亡率的变化。结果：乳酸林格液复苏组、高渗盐水复苏组2组氧分压（PaO2）、谷丙转氨酶（ALT）、尿素氮（BUN）和肌酸激酶（CK）等主要器官功能指标在24h和36h均高于正常对照组,差异有统计学意义（P〈0.01）。同时高渗盐水复苏组PaO2、ALT、BUN和CK在24h和36h（除PaO2）高于乳酸林格液复苏组,差异有统计学意义（P〈0.01）。MODS发生率高渗盐水复苏组为20.8%,较乳酸林格液组（41.7%）明显降低（P〈0.05）。高渗盐水复苏组大鼠48h内死亡率为14.2%,较乳酸林格液复苏组（28.6%）明显降低（P〈0.05）。48～72h高渗盐水复苏组大鼠死亡率为21.4%,明显低于乳酸林格液复苏组（35.7%）,差异有统计学意义（P〈0.05）。结论：7.5%高渗盐水复苏失血性休克可明显减轻失血性休克复苏后大鼠再次予以内毒素打击时所引起的重要脏器功能损害,并且可明显降低MODS的发生率和死亡率。

Objective： To observe the influence of different fluid resuscitation on multiple organ dysfunction syndrome associated with hemorrhagic shock followed by resuscitation and endotoxin. Methods： Ninty healthy SD rats were randomly divided into the normal contral group （NC group, n =30）, the Ringer＇s solution group （RS group, n 30） and 7.5% hypertonic saline resuscitation group （HTS group, n =30）. Hemorrhagic shock model was reproduced in RS and HTS groups by bloodletting through catheter inserted into carotid artery. Heparin blood transfusion by the catheter inserted into the tail vein to maintain the mean arterial pressure at about 40 mmHg for 1 hour. Then haprin blood and two different fluid infusion were performed to RS and HTS groups. Half hour after successfully resuscitated, RS and HTS group were injected endotoxin. And specimens were colleted at 24 h and 36 h after injected endotoxin. Main organ function index, the incidence of MODS and the mortality of three groups were observed. Results： The serum contents of PaO2, ALT, BUN, and CK in RS and HTS groups have signifcant different compared with NC group. The serum contents of PaO2, ALT, BUN, and CK between RS snd HTS groups have significant different （P 〈0.01）. The injury of main organ were mitigated in HTS group than in RS group. The incidence of MODS in HTS group was 20.8%, siginificant lower than RS group which was 41.7% （P 〈 0.05）. Meanwhile, the mortality at 72 h and 36 h of HTS group were 14.2% and 21.4%, siginificant lower than RS group （P 〈0.05）, which were 26.6% and 35.7%. Conclusions： 7.5% hypertonic saline could reduce the main organ injure on MODS rays associated with hemorrhagic shock followed by resuscitation and endotoxin and it could also seriously reduced the incidence of MODS and the mortality of MODS.