异丙酚对失血性休克复苏大鼠应激激素和免疫平衡的影响

The influences of propofol on corticosteroid and immunity of rats after hemorrhagic shock and resuscitation

目的观察异丙酚对失血性休克复苏后大鼠应激激素、细胞因子的影响及对重要脏器的保护作用。方法雄性Wistar大鼠66只被随机分为对照组、失血性休克复苏组和异丙酚治疗组。制备失血性休克复苏动物模型后，异丙酚组经股静脉输注异丙酚10mg^-1·kg^-1·h^-1，休克复苏组输注等量生理盐水。休克复苏组和异丙酚组分别于术后30、60、120、180和240min取6只大鼠，采集腹主动脉血及肺和小肠组织标本，用酶联免疫吸附法（ELISA）检测血浆皮质醇、γ-干扰素（IFN-γ）和白细胞介素-4（IL-4）水平，光镜下观察肺和小肠组织病理学改变，并行组织病理学评分。结果与对照组比较，休克复苏组大鼠血浆皮质醇水平明显降低（P均〈0．01）；IFN-γ和IL-4呈进行性升高，IFN-γ／IL-4比值随病程进展逐渐下降（P均〈0．01）；肺和小肠组织损伤明显，病理学评分显著增加[肺：（3．09±0．56）分比（0．31±0．25）分，小肠：（7．61士1．20）分比（0．86±0．72）分，P均〈0．01]。异丙酚组低皮质醇血症程度降轻，IFN-γ和IL-4升高程度降低，IFN—γ／IL-4比值下降趋于减缓（P〈0．05或P％0．01）；肺和小肠组织损伤明显减轻，病理学评分显著降低（肺：（1．27土0．40）分，小肠：（3．69±1．28）分，P均〈0．013。结论异丙酚可减轻失血性休克复苏大鼠的低皮质醇血症，调节炎症反应，保护重要脏器。

Objective To observe the influence of propofol on corticosteroid, and cytokines in rats after hemorrhagic shock and resuscitation, as well as its protective effects on vital organs. Methods Sixty- six male Wistar rats were randomly divided into three groups： control group, hemorrhagic shock and resuscitation group and propofol treatment group. After the model of hemorrhagic shock and resuscitation was reproduced, propofol was infused in propofol treatment group at the speed of 10 mg · kg^-1 · h^-1 via femoral vein, while equal amount of normal saline was infused in hemorrhagic shock and resuscitation group. Abdominal aortic blood, lung and small intestinal tissue samples were collected at 30, 60, 120, 180 and 240 minutes, 6 rats at each time point in hemorrhagic shock and resuscitation group and propofol treatment group. Plasma cortisol, interferon-γ （IFN-γ） and interleukin-4 （IL-4） concentrations were measured using enzyme linked immunosorbent assay （ELISA）. Histopathologieal changes in lung and small intestine were observed using optical microscope and then histopathological scores were assessed. Results Comparing with control group, the concentration of cortisol in plasma decreased significantly （all P〈0. 01）, both IFN-γ and IL-4 increased progressively, and the IFN-γ/IL-4 ratio decreased gradually with the progress of the course （all P〈0. 01）. Serious injury to lung and small intestinal tissue was observed, and remarkable elevation of histopathological scores was found in hemorrhagic shock and resuscitation group （lung： 3.09±0. 56 vs. 0. 31±0. 25, small intestine： 7.61±1.20 vs. 0. 86±0.72, both P〈0. 01）. In propofol treatment group, the extent of decrease in corticosteroid level was lessened, the extent of elevation of IFN-γ and IL-4 was decreased, the downward trend of the IFN-γ/IL-4 ratio was slowed down （P〈0. 05 or P〈0. 01）, the extent of injury to lung and small intestinal tissue was alleviated and histopathological scores were reduced remarkably （lung： 1.27±0. 40, small intestine.. 3.69±1.28, both P〈0. 01）. Conclusion Propofol can ameliorate the lowering of corticosteroid secretion, moderate inflammatory response, and protect vital organs in rats with hemorrhagic shock.