不同液体小容量复苏对内毒素休克大鼠肺损伤的影响

Effects of Small Volume Resuscitation with Different Fluids on Lung of Rats Undergoing Endotoxic Shock

【目的】探讨不同液体小容量复苏对大鼠内毒素休克所致肺损伤的影响。【方法】清洁级SD大鼠30只随机分为5组,正常对照组(C组)、内毒素(LPS)对照组(LPS,E组)、75g/L高渗氯化钠(HSS)组(LPS+HSS,HSS组)、羟乙基淀粉液130/0.4(HES)组(LPS+HES,HES组)、75g/L高渗氯化钠羟乙基淀粉40溶液(HSH)组(LPS+HSH,HSH组)。各组在静注LPS(1mg/kg)30min后予小容量复苏(4ml/kg)干预。观察各组大鼠肺组织病理学变化,测定肺组织干/湿质量比例,测定肺泡灌洗液中蛋白浓度,测定肺组织丙二醛(MDA)的浓度以及超氧化物歧化酶(SOD)的活性。【结果】与空白对照组比较,内毒素模型各组病理改变均加重,肺泡灌洗液蛋白浓度均升高(P<0.05),内毒素对照组病理评分升高(P<0.01),干/湿质量比例下降(P<0.05),SOD活性下降(P<0.01),内毒素对照组和75g/L高渗氯化钠组MDA浓度升高;与内毒素对照组比较,75g/L高渗氯化钠组,羟乙基淀粉130/0.4溶液组和75g/L高渗氯化钠羟乙基淀粉40组,病理改变减轻,肺病理评分、MDA浓度下降(P<0.01),干/湿质量比例升高(P<0.05),SOD活性升高(P<0.01)。羟乙基淀粉130/0.4溶液组和75g/L高渗氯化钠羟乙基淀粉40组肺泡灌洗液中蛋白浓度下降(P<0.05,P<0.01)。【结论】使用75g/L高渗氯化钠,羟乙基淀粉130/0.4溶液和75g/L高渗氯化钠羟乙基淀粉40进行小容量复苏对大鼠内毒素休克所致肺损伤有明显保护作用。相比75g/L高渗氯化钠,羟乙基淀粉130/0.4溶液和75g/L高渗氯化钠羟乙基淀粉40在减轻肺毛细血管通透性方面作用更佳。

【Objective】 This study was designed to investigate the effects of small volume resuscitation with different fluids on the lung of endotoxic rats. 【Methods】 Thirty SD rats weighting 180 ～ 250 g were divided randomly into 5 groups （n = 6）： Group C [lipopolysaccharide （LPS） negative control group], Group E （LPS ＋ 4 mL/kg physiologic saline）, Group HSS （LPS ＋ 4 mL/kg 75 g/L hypertonic saline solution）, Group HES （LPS ＋ 4 mL/kg hydroxyethyl starch 130/0.4）, Group HSH （LPS ＋ 4 mL/kg 75 g/L hypertonic sodium chloride hydroxyethyl starch 40）. Resuscitation was administrated 30 min after LPS injected. Pathological examination and score were made under optical microscope. Dry/wet ratios were observed. Levels of total protein of bronchoalveolar lavage fluid （BALF） were measured. Thibabituric acid （TBA） was used to measure tissue malonaldehyde （MDA） levels. Xanthine oxidase （XO） was employed to measure the tissue activity of superoxide dismutase （SOD）. 【Results】 Compared with group C, in the other 4 groups, pathological changes were server. Levels of total protein of BALF were higher （P〈0.05）. Pathological score of group E was significantly higher （P〈0.01）. Dry/wet ratio of group E was lower （P〈0.05）. Tissue activity of SOD of group E was lower （P〈0.01）. Levels of tissue MDA in group E and HSS were significantly higher. Compared with group E, in group HSS, HES and HSH, pathological changes were slighter （P〈0.01）. Pathological scores and tissue MDA levels were lower （P〈0.01）. Dry/wet ratios were higher （P〈0.05）. Tissue activity of SOD were higher （P〈0.01）, levels of total protein of BALF were lower （P〈0.05, P〈0.01）. 【Conclusion】 Small volume resuscitation with HSS, HES, and HSH had protective effects on the lung of endotoxic rats. HES and HSH had better effect on decreasing the capillary permeability of the lung of endotoxic rats lung compared with HSS.