不同补液对急性呼吸窘迫综合征SD大鼠凝血功能的影响

Different infusion on blood coagulation of acute respiratory distress syndrome SD rats

目的研究不同种类的补液对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)SD大鼠液体复苏时凝血功能的影响。方法气管内滴注内毒素(lipoplysaccharide,LPS)10mg/kg,建立大鼠ARDS模型。取36只雄性SD大鼠(体重300±10g)随机分为预实验组(18只)和实验组(18只),其中预实验组分为3组,每组6只,为气管滴入LPS后1h组、1.5h组、2h组分别检测动脉血气以确定从气管滴入LPS后到稳定建立ARDS模型所需时间。实验组分为3组,分别为0.9%氯化钠注射液组、葡萄糖40右旋糖酐注射液组、20%人体白蛋白组,并按预实验组得出的时间,确定ARDS建模稳定后各补液组分别开始予以相对应的补液持续补液3h,补液3h后准时取大鼠心尖血检测凝血指标,处死大鼠并采集肺组织标本,观察经不同补液复苏治疗后的SD大鼠重要凝血指标变化,及肺部标本示肺损伤情况。结果①预实验组确定从气管内滴入内毒素到ARDS模型建立稳定用时约为1.5h;②实验组中0.9%氯化钠注射液组纤维蛋白含量(FIB)、葡萄糖40右旋糖苷注射液组FIB和20%人体白蛋白组FIB三组数据两两相比组间P<0.01,有显著统计学差异。氯化钠注射液组凝血酶原时间(PT)、葡萄糖40右旋糖苷注射液组PT和20%人体白蛋白组PT之间:0.9%氯化钠组与葡萄糖40右旋糖酐组组间P>0.05,无明显统计学差异。0.9%氯化钠组与人体白蛋白组P<0.01。有明显统计学意义。葡萄糖40右旋糖酐组与人体白蛋白组组间P<0.01有明显统计学意义。氯化钠注射液组凝血酶时间(TT)、葡萄糖40右旋糖苷注射液组TT和20%人体白蛋白组TT三组数据两两相比P>0.05无明显统计学差异;③组织HE染色示:气管滴素1.5h后SD大鼠肺大体标本可见明显局灶性出血,HE染色显微镜下见肺泡壁水肿、断裂,肺泡腔内炎性细胞和大量红细胞浸润。使用0.9%氯化钠注射液、葡萄糖40右旋糖酐注射液、20%人体白蛋白补液3小时后取肺组织HE染色后镜检示:使用20%人体白蛋白治疗的大鼠肺泡壁水肿断裂程度及肺泡腔炎性细胞、红细胞浸润程度明显轻于使用0.9%氯化钠注射液和葡萄糖40右旋糖苷注射液治疗组,使用0.9%氯化钠注射液治疗组大鼠肺泡壁水肿破坏程度及肺泡腔炎性细胞、红细胞浸润程度轻于葡萄糖40右旋糖苷注射液治疗组。结论对气管滴入LPS后导致的ARDS SD大鼠使用白蛋白补液复苏治疗,对减轻凝血功能紊乱和肺组织损伤疗效优于0.9%氯化钠注射液和葡萄糖40右旋糖苷注射液。

Objective Acute respiratory distress syndrome （ARDS） and acute lung injury （ALI） are important clinical problems in critical care medicine. How to choose fluid resuscitation is still in controversy. By measuring the blood coagulation functions, we studied the effects of differentfluid managements on ALI/ARDS in a rat model. Methods The model was established by direct intra-traeheal dropping of lipoplysaccharide （LPS, 10mg/kg ）. A total of 36 male rats （weighted 300 ＋ 10g） were equally divided into 2 groups. The pre-experimental group was further divided into 3 subgroups by the time node after treatment of LPS （1h, 1.5h and 2h）. The time of model estab- lishment was determined by the arterial blood gas analysis obtained from each subgroup. The experi- ment group was also divided into 3 subgroups by different fluid management： the NaCl group, the Dextran group and the albumin group. After 3 h of fluid resuscitation, we took the apical blood for coagulation function examination and the lung tissue for pathological observation. All the groups were divided randomly. Results （1）The time of ARDS model establishment was about 1.5 hours in average after treatment of LPS ; （2） The fibrin （FIB） among all 3 experiment groups was significant different （P 〈0.01 ）. The prothrombin time （TT） between NS-group and Dextran-group had no significant difference （ P 〉 0.05 ） , while which of the other two comparisons （ NS-group and Albu- min-group; Dextran-group and Albumin-group） had significant difference （P 〈 0.01 ）. The throm- bin time （TT） among all 3 experiment groups had no significant different （P 〉0.05）. （3）The lung tissues showed local hemorrhage 1.5 h after the LPS treatment. The HE-stains show edema and rup- ture of alveolar wall, soakage of inflammatory cell and red-blood-cell in alveolus. The degree of soakage, edema and rupture of Albumin-group was the lightest, and the Dextran-group had the most severe pathological damage. Conclusion The Human albumin was best for the fluid resuscitation of ARDS rats caused by LPS, which had better effect in remission of blood coagulation function and lung tissue damage.