液体复苏对重症急性胰腺炎胰组织微血栓形成的影响

Influence of fluid resuscitation on pancreatic microthrombosis in severe acute pancreatitis

目的:应用7.5%高渗盐水(HS)或低分子右旋糖酐40(Dx)进行液体复苏,观察和评价重症急性胰腺炎(SAP)大鼠胰组织微血栓形成和微循环障碍的变化和治疗效果。方法:SD大鼠随机分为4组,SAP组、HS组、Dx组于建模后经尾静脉持续注射4 mL/kg生理盐水、HS组及Dx组各2 h,另设假手术组(OS)。12 h后检测血清淀粉酶、血浆D-二聚体(D-dimer)、血管性血友病因子(vWF)、GMP-140,同时测定腹水量,采集胰腺作普通病理检查并计数微血栓,部分作透射电镜检查。结果:(1)SAP诱发后12 h,SAP组的存活率显著低于HS组或Dx组(P<0.05);治疗组存活数虽有不同,但组间比较无显著差异。(2)胰组织病理学观察显示,HS组或Dx组微血栓数、病理评分显著少于SAP组(P<0.05);腹水量、淀粉酶、D-dimer、vWF、GMP-140等检测结果也显示HS组或Dx组较SAP组显著改善(P<0.05或P<0.01);但HS组或Dx组间比较无显著差异。结论:早期采用HS或Dx进行液体复苏能提高SAP大鼠生存率,胰腺病理损害减轻,胰组织微血栓数量减少,与出血、凝血机制紊乱相关的指标如D-dimer、vWF、GMP-140等改善。本研究未显示HS与Dx在改善SAP上述有关指标方面有统计学显著差异。

AIM： To make evaluation on fluid resuscitation with either hypertonic saline （HS） or dextran 40 （Dx） on pancreatic microthrombi and dysfunction of microcirculation in rats with severe acute pancreatitis （SAP）. METHODS： SD rats were allocated into 4 groups randomly, ie. SAP group, HS group, Dx group, which respectively received normal saline （NS, 4 mL/kg）, HS （4 mL/kg）, Dx （4 mL/kg） for 2 h by the tail intravenous injection consecutively after being made as SAP animal models, and operate sham group （OS）. 12 h after the operation, all animals were blooded to assess the serum amylase levels, plasma D - dimer, yon Willebrand factor and GMP - 140 levels. The amount of ascites was measured and the samples of the pancreas were collected for pathologic examination under light microscopy as well as transmission electron microscope. The numbers of pancreatic microthrombi were also counted with microscopy. RESULTS： （1） 12 h later when the rats were sacrificed, the survival rate in SAP group was the lowest, significantly lower than that in the 2 fluid resuscitation groups （P 〈 0. 05）. However, no significant difference was found between the latter 2 groups though the survival numbers. （2） The numbers of microthrombi in the pancreas and the histological scoring of pancreatic injury were significantly fewer in the 2 fluid resuscitation groups than those in SAP group （P 〈 0. 05 ） though no significant difference was revealed between the 2 treated groups. The amounts of ascites, serum amylase, plasma D - dimer, yon Willebrand factor and GMP - 140 showed significant improvement in HS or Dx group compared to those in SAP group （P 〈0. 05, P 〈0. 01 ）. However, no significant difference was found between the 2 fluid resuscitation groups. CONCLUSION ： Fluid resuscitation with HS or Dx, if applied at the early stage, increases survival rate with lessened histological injury, fewer microthrombi and improved coagulation parameters including D - dimer, yon Willebrand factor and GMP - 140. Either hypertonic saline （HS） or dextran 40 （Dx） demonstrates the same improvement in the relevant laboratory parameters in SAP.