腹腔复苏对失血性休克家兔肠黏膜屏障的影响

Effects of peritoneal resuscitation on intestinal mucosal barrier of rabbit with hemorrhagic shock

目的研究腹腔复苏对失血性休克家兔足量液体复苏后肠黏膜屏障的影响。方法 21只雄性家兔随机分为3组:对照组(A组)、常规静脉复苏组(B组)、腹腔复苏组(C组)。利用三通管放血将B、C组家兔的平均动脉压于10min内降至40mm Hg,维持60min后,在20min内静脉回输所放血液和2倍于放血量的复方乳酸钠溶液,同时,C组家兔腹腔内注射120mL透析液,而A、B组腹腔注入等量生理盐水对照。检测休克前及复苏3h后静脉血二胺氧化酶(DAO)和脂多糖(LPS)的含量。于观察终点,取距回盲部5cm的一段回肠,测定组织干湿质量比、丙二醛(MDA)、超氧化物歧化酶(SOD),并观察其形态学改变。结果复苏3h后C组家兔静脉血DAO、LPS的浓度及其回肠组织MDA水平较B组低(P<0.05),而其组织干湿质量比、SOD水平高于B组(P<0.01),且组织损伤程度较B组轻。结论腹腔复苏可能通过阻止组织间隙的液体潴留和抑制脂质过氧化反应而减轻失血性休克家兔肠黏膜的损伤。

Objective To study the effects of peritoneal resuscitation on intestinal mucosal barrier of rabbits with hemorrhagic shock after adequate fluid resuscitation.Methods 21 male rabbits were randomly divided into 3 groups：control group（group A）,conventional intravenous resuscitation group（group B） and peritoneal resuscitation group（group C）.Average arterial blood pressures of rabbits in group B,C were lowered to 40 mm Hg within 10 min via bloodletting using three-way pipe.After 60 min maintenance,all released blood and compound sodium lactate solution equivalent to 2 times of released blood by volume were transfused back within 20 min,meanwhile,rabbits in group C were given intraperitoneal injection of 120 mL of dialysis fluid,while those in group A and B received intraperitoneal injection of equivalent volume of physiological saline as control.Concentration of diamine oxidase（DAO） and lipopolysaccharide（LPS） in venous blood were detected before shock and 3 h after resuscitation.Ileum tissue located 5 cm from the ileocecal valve were taken to detect their wet and dry tissue mass ratio,malondialdehyde（MDA）,superoxide dismutase（SOD）,and to observe their morphological changes.Results After 3 hours resuscitation,concentration of DAO and LPS in venous blood,levels of MDA in ileum tissue of rabbits in group C were lower（P0.05） than those in group B,and wet and dry tissue mass ratio,levels of SOD in ileum tissue of rabbits were higher（P0.01）.The extent of tissue damage was milder in group C than in group B.Conclusion Peritoneal resuscitation can decrease the intestinal mucosa damage induced by hemorrhagic shock in rabbits via preventing interstitial fluid retention and inhibiting lipid peroxidation.