电针足三里穴对致死性失血性休克延迟补液大鼠生存率和脏器功能指标的影响

Effects of electro-acupuncture of Zusanli point (足三星穴) on the survival rate and organ functional index of the rat with delayed fluid replacement after fatal hemorrhagic shock

目的:研究电针足三里穴对致死性失血性休克延迟补液大鼠生存率和脏器功能指标的影响,探讨其对液体复苏疗法的替代作用。方法:36只SD雄性大鼠,体重(270±20)g,按全血容量的45%放血制成致死性失血性休克模型。随机分为3组:即刻补液组、非经非穴+延迟补液组和足三里+延迟补液组,每组12只。即刻补液组于失血后10 min即行补液。足三里+延迟补液组于失血后10 min电针足三里穴(3 Hz,3.8 V,持续刺激25 min,);非经非穴+延迟补液组电针非经非穴部位,其他操作同足三里+延迟补液组。后两组均于失血后3 h实施延迟补液。测定失血前和失血后0、1、3、12、24 h平均动脉压(MAP)及丙氨酸转氨酶(ALT)、肌酐(Cr)和肌酸激酶同工酶(CK-MB)水平,记录24 h生存率。结果:失血后即刻3组大鼠的MAP均显著降低,之后足三里+延迟补液组和即刻补液组MAP明显回升,于3 h后均显著高于非经非穴+延迟补液组(P<0.05);失血后24 h足三里+延迟补液组与即刻补液组MAP接近正常水平(P>0.05)。失血后3组血浆ALT、CK-MB和Cr等脏器功能指标均较失血前显著升高;足三里+延迟补液组失血后3 h起各脏器功能指标显著低于非经非穴+延迟补液组(P<0.05),失血后24 h足三里+延迟补液组与即刻补液组各脏器功能指标无明显差异。足三里+延迟补液组和即刻补液组失血后12 h生存率均显著高于非经非穴+延迟补液组,足三里+延迟补液组24 h生存率低于即刻补液组,但差异无显著性(P>0.05)。结论:电针足三里穴能有效提高致死性失血性休克大鼠MAP,减轻脏器功能损害,提高早期生存率,提示失血性休克现场救治无即刻补液条件时,电针足三里穴能部分替代乳酸林格液的治疗效应。

Objective：To investigate the effect of electro-acupuncture of Zusanli points （足三里穴） on the survival rate and organ functional indexes of the rats with delayed fluid replacement after fatal hemorrhagic shock, and to discuss the role of Zusanli point as a supplement to fluid resuscitation. Methods：Thirty-six SD rats with 45% blood loss were randomly divided into three groups （n=12） ： instant fluid resuscitation （IFR）, delayed fluid resuscitation （DFR）, and DFRq-Zusanli point stimulation groups. Rats in IFR group were given fluid replacement 10 minutes after blood loss. Electroacupuncture of Zusanli point was performed for 25 minutes （3 Hz, 3.8 V） 10 minutes after blood loss in rats of DFR＋Zusanli point stimulation group, while electroacupuncture of random acu- puncture points was conducted in rats of DFR group. In the two DFR group, fluid was given 3 hours after blood loss. The mean arterial pressure （MAP）, the levels of alanine aminotransferase （ALT）, creatinine （Cr） and MB isoenzyme of creatine kinase （CK-MB） were measured before hemorrhage（-0. 3 hours） and 0, 1,3, 12 and 24 hours after hemorrhage, and the 24-hour survival rate after hemorrhage was recorded. Results：All the rats in three groups showed significant lowering of MAP after blood loss, but an obvious elevation of MAP was observed in groups of DFR＋Zusanli points stimulation and IFR groups, and it was significantly higher than that in DFR group （P〈0. 05） 3 hours later. At the 24th hour, MAP in group of DFR＋Zusanli point stimulation and IFR groups approximated to that of the normal level （P〉0.05）. The levels of ALT, CK-MB and Cr all increased significantly in three groups compared with those before blood loss, but they were significantly lower in DFR＋ Zusanli point stimulation group compared with those of the DFR group（P〈0.05）, and no significant difference was shown between DFR＋Zusanli point stimulation group and IFR group 24 hours after blood loss. The 12-hour survival rates of DFR＋Zusanli point stimulation group and IFR group were significantly higher than that of DFR group, while the 24-hour survival rate of DFR＋Zusanli point stimulation group was lower than that of IFR group, but the difference was not significant（P〉0.05）. Conelusions：Electroacupuneture of Zusanli point conduces to an elevation of MAP in rats with delayed fluid resuscitation after fatal hemorrhagic shock, alleviation of organ functional dam- age, and an increase in survival rate at the early stage. It is suggested that if there were no adequate establishment for instant fluid resuscitation at the site of injury with fatal hemorrhagic shock, electroaeupuneture of Zusanli points can partially complement the therapeutic effect of Lactated Ringer＇s solution.