不同复苏液体对脓毒性休克兔心肌病理学的影响

Effect of Different Fluid Resuscitation on Myocardial Pathomorphism in Rabbit With Septic Shock

目的:观察不同液体对脓毒性休克兔复苏后心肌病理学的影响,并探讨其机制。方法:雄性新西兰大白兔40只,随机平均分为假手术组(S)、生理盐水复苏组(NS)、4.2%高渗盐复苏组(4.2%HS)、羟乙基淀粉(130/0.4)复苏组(HES)、4.2%高渗盐+羟乙基淀粉1∶1混合液体复苏组(HHS),每组8只。应用改良盲肠结扎穿孔制作脓毒性休克兔模型。各复苏组根据统一复苏方案,以不同种类液体进行容量复苏,复苏6h取血离心,ELISA法测血清iNOS浓度,处死动物后取心肌组织做病理学检查。结果:HE染色可见各复苏组心肌细胞水肿及嗜酸性变表现,其病理学改变严重程度由重到轻依次为:4.2%HS组、NS组、HES组、HHS组。血清iNOS浓度显示:各组血清iNOS浓度由高到低依次为NS组、4.2%HS组、HES组、HHS组。与假手术组比较,NS组、4.2%HS组血清iNOS浓度明显增加(P<0.01),HES组血清iNOS浓度轻度增加,但无统计学差异(P>0.05),而HHS组血清iNOS浓度还稍低于假手术组(P>0.05)。结论:HHS可通过抑制血清iNOS浓度升高而减轻脓毒性休克兔心肌病理学损伤。

Objective：To observe the effect of different fluid resuscitation on myocardial pathomorphism in rabbit with septic shock,and to explore its machenism. Methods：Forty New Zealand rabbits were randomly divided into four groups：sham group （S group）,normal saline resuscitation group （NS group）,4.2% hypertonic saline resuscitation group （4.2% HS group）,hydroxyethyl starch （130/0.4） resuscitation group （HES group）,4.2% hypertonic saline plus hydroxyethyl starch 1：1 mixture resuscitation group （HHS group）,eight rabbits for each group. Resuscitation groups resuscitated with NS,4.2%HS,HES and HHS according to the same resuscitation scheme. After 6 hours of resuscitation,rabbits were executed,and the content of iNOS was tested by means of ELISA. Myocardium tissue was observed under the microscope with HE stain. Results：Pathomorphism changes of myocardium in all resuscitation groups were myocardium cells edema and eosinophilic degeneration. The above changes were moderate in 4.2% HS group,and less in HES and HHS group. Serum concentrations of iNOS in NS group,4.2%HS group,HES group and HHS group were sequentially increasing. Compared with S group,concentration of iNOS significantly increased in NS group and 4.2%HS group （P〈0.01）,slightly increased in HES group,but no statistic significance was found （P〉0.05）. However,concentration of iNOS in HHS group was a little lower than that in S group （P〉0.05）. Conclusion：HHS can reduce rabbit myocardial pathological injury induced by septic shock through decreasing the serum iNOS.