优降糖和碳酸氢钠对重症低血容量性休克大鼠的联合治疗作用

The role of glybenclamide combined with NaHCO3 in the treatment of rats with severe hemorrhagic shock

目的：通过在体局部和全身给予ＡＴＰ敏感钾通道特异性阻滞剂优降糖和碳酸氢钠治疗，探讨重症休克时低血管反应性的发生机制，以寻找有效的治疗措施。方法：对３３只ＳＤ大鼠制作脊斜肌微循环观察标本，复制重症低血容量性休克模型。实验分局部治疗组〔在脊斜肌表面滴加优降糖和（或）碳酸氢钠〕和全身治疗组（通过股静脉注射优降糖和碳酸氢钠），分别观察药物对休克大鼠血管反应性、血压、微动脉血流量和２４小时存活率的影响。结果：局部治疗后，休克大鼠血管反应性明显升高，以优降糖和碳酸氢钠联合应用效果最为显著。全身治疗后，休克大鼠血压、微动脉血流量和２４小时存活率显著提高。结论：重症休克引起ＡＴＰ敏感钾通道激活以及酸中毒参与了低血管反应性的发生，优降糖与碳酸氢钠联合应用对重症低血容量性休克具有较好的治疗作用。

Objective :With glybenclamide treatment,a specific blocker of ATP sensitive potassium(KATP) channel and NaHCO3 locally or systematically,to explore the mechanism of vascular hyporeactivity in severe shock and seek an effective therapeutic regimen for improving vasoreactivity after severe shock. Methods :The sample of spinotrapezius muscle of rats were prepared to observe microcirculation,and severe hemorrhagic shock model was produced in rats.Local treatment group and systemic treatment group were included in this study.In the former group,glybenclamide and(or) NaHCO3 were added to the surface of spinotrapezius muscle, and in the latter group,glybenclamide and NaHCO3 were injected through femoral vein.The effects of the drugs on vasoreactivity,blood pressure,arteriolar blood flow and 24 hour survival rate were observed in rats. Results :Vasoreactivity of shock rats increased significantly after local treatment,especially treatment of glybenclamide combined with NaHCO3.After treatment systematically blood pressure,arteriolar blood flow and 24 hour survival rate of shock rats increased markedly. Conclusions :The activation of KATP channels and acidosis induced by severe hemorrhagic shock may be involved in the pathogenesis of vascular hyporeactivity following severe shock.Glybenclamide combined with NaHCO3 is an effective regimen in the treatment of severe hemorrhagic shock.