不同液体复苏方法对孕兔失血性休克各脏器ATP酶活性的影响

Effects of hypotensive or aggressive resuscitation on tissue ATPase activity in pregnant rabbits with uncontrolled hemorrhagic shock

目的:探讨限制性液体复苏对非控制性失血性休克孕兔腹腔内失血量、补液量、血细胞比容(Hct)及各脏器Na+-K+-ATP酶活性和Ca2+-Mg2+-ATP酶活性的改变,以分析其对休克后近期能量代谢的影响。方法:将30只孕中晚期新西兰大白兔随机分为5组:(1)假休克组(SS);(2)休克未处理组(SH);(3)传统复苏组(NS);(4)生理盐水限制性输液复苏组(NH);(5)高渗高胶液体限制性复苏组(HHH)。实验设计分为休克期(T0-T30 min)、休克复苏期T30(T30-T90 min)及休克复苏期T180(T90-T180 min)。休克期:除SS组外各组动物均接受离断子宫系膜小动脉及颈动脉放血至平均动脉压(MAP)40-45 mmHg,制作非控制性失血性休克模型。休克复苏期T30:NS组接受生理盐水(4 mL/kg)及林格氏液快速输注以维持MAP在80 mmHg左右;NH、HHH组接受生理盐水(4 mL/kg)或高渗高胶液(6%羟乙基淀粉+7.5%氯化钠)(4 mL/kg)及林格氏液输注以维持MAP在60mmHg左右。休克复苏期T180:除SS组外各组动物均接受手术止血及输血输液治疗。实验中监测血细胞比容(Hct),统计腹腔内失血量、补液量。实验结束后处死动物取心脏、肺脏、肝脏、肾脏、小肠和骨骼肌组织检测Na+-K+-ATP酶、Ca2+-Mg2+-ATP酶活性。结果:腹腔内失血量与补液量:NH[(4.3±0.2)mL/kg,(47.2±4.1)mL/kg]与HHH[(4.1±0.3)mL/kg,(44.9±4.3)mL/kg]均明显低于NS[(5.5±0.2)mL/kg,(65.5±3.8)mL/kg]。T180 min:Hct在NH(21.0%±2.1%)与HHH(21.5%±1.8%)均显著高于NS(14.2%±1.5%)及SH(12.5%±1.4%)。失血性休克引起Na+-K+-ATP酶、Ca2+-Mg2+-ATP酶活性的升高;其中骨胳肌、心肌、肝、肾组织Na+-K+-ATP酶活力在NH(5.42±1.41,4.54±2.01,4.13±0.62,3.42±0.84)与HHH(3.97±0.91,2.94±0.66,3.22±1.42,3.03±0.53)均显著低于NS(7.34±1.41,6.23±1.53,6.11±0.97,5.82±0.69)与SH(9.11±0.52,8.40±1.08,7.04±1.13,6.55±1.45);肺及肠组织中,NH、HHH、NS组比较无显著差异。结论:孕兔非控制性失血性休克后导致能量代谢障碍,不同器官影响不同,其中心肌和骨胳肌ATP酶活性改变显著。传统复苏加剧了能量代谢的紊乱,限制性复苏相对稳定了能量代谢,减轻对细胞生物膜及细胞器的损害。

AIM： To compare the effects of hypotensive and aggressive resuscitation strategies on blood loss, fluid requirements, hematocrit （ Hct）, tissue Na^＋ - K^＋ - ATPase and Ca^2＋ - Mg^2＋ - ATPase activities in a clinically relevant model of uncontrolled hemorrhagic shock in pregnancy rabbits. METHODS ： Thirty anesthetized New Zealand white rabbits at mid and late gestation underwent uncontrolled hemorrhagic shock by transecting a small artery of mesometrium, followed by bleeding via carotid artery to mean arterial pressure （MAP） of 40 -45 mmHg. Animals were randomly divided into five groups （n = 6 each） ： sham shock （SS） ; shock without resuscitation （SH） ; aggressive resuscitation in pre -hospital phase with 4 mL/kg normal saline, followed by Ringer＇s solution to MAP of 80 mmHg （ NS）, hypotensive resuscitation with 4 mL/kg of normal saline （NH） or hypertonic hydroxyl ethyl starch （7. 5% NaCl ＋ hydroxy ethyl starch, HHES,HHH） followed by Ringer＇s solution to MAP of 60 mmHg. Finally, all the resuscitated animals received hemorrhage controlled and fully resuscitated to MAP of 80 mmHg. At the end of the experiment, survivors were sacrificed, skeletal muscle, cardiac muscle, liver, kidney, lung and ileum were harvested for determination of Na^＋ - K^＋ - ATPase and Ca^2＋ - Mg^2＋ -ATPase activities. RESULTS： Total blood loss and infused volume were compared between NH [ （4. 3± 0. 2）mL/ kg, （47. 2 ±4. 1）mL/kg] and HHH[ （4. 1 ±0. 3）mL/kg, （44. 9 ±4. 3） mL/kg] groups, both were significantly less than NS[ （5.5 ±0. 2） mL/kg, （65.5 ±3.8） mL/kg] group. Hct in NH （21.0% ±2. 1% ） and HHH （21.5% ± 1.8% ） were significantly higher than NS （ 14. 2% ± 1.5% ） and SH （ 12. 5%± 1.4% ）. Tissue Na^＋ - K^＋ - ATPase and Ca^2＋ - Mg^2＋ -ATPase activities were stimulated in all shock groups. Na^＋ -K^＋ -ATPase in skeletal muscle, cardiac muscle, liver, kidney was significantly lower in the NH （5.42 ± 1.41, 4. 54± 2. 01, 4. 13 ± 0.62, 3.42 ± 0. 84） and HHH （ 3.97 ± 0.91, 2. 94±0.66, 3. 22±1.42, 3.03±0.53） than that in NS （7.34±1.41, 6. 23±1.53, 6.11 ±0.97, 5.82± 0. 69） and SH （9. 11 ±0. 52, 8.40 ±1.08, 7.04±1.13, 6. 55 ±1.45）. CONCLUSION： Hypotensive resuscitation with normal saline or HHES reduces blood loss, decreses total infused volume, leads to higher hematocrit and finally alleviates metabolism derangement after uncontrolled hemorrhagic shock.