超声监测聚环氧乙烷对内毒素休克兔肝脏血流的影响

Effect of Polyethylene Oxide on Hepatic Hemodynamics of Septic Shock in Rabbits by Ultrasonic Monitoring

【目的】探讨聚环氧乙烷（PEO）对感染休克后肝脏血流的影响及对肝脏的保护作用。【方法】健康新西兰白兔20只随机分为对照组（NS组）和PEO组，每组10只，禁饮食12h，静脉注射内毒素0．6mg／kg造成感染休克。PEO组使用含50ppm聚环氧乙烷的生理盐水的进行复苏，Ns组使用生理盐水复苏，均为5mL／（h·kg）。比较两组休克前期（T。）、休克期（T。）和复苏后（T。）肝脏门静脉（PV）、肝固有动脉（HA）血流速度及炎症因子。【结果】两组白兔T2时血压较T，时进一步降低（P〈0．05），但PEO组T。时的血压显著高于NS组（P〈0．05）；T2时PEO组PV、HA血流的最高流速（HAVmax）和最低流速（HAVrain）均比T。时高（P〈O．05），但仍低于To时水平（P〈O．05），而NS组复苏后PVmax进一步降低（P〈O．05），PVmin、HAVmax、HAVmin则有所增高（P〈0．05），但仍明显低于T。时水平（P〈0．05），且复苏后的各血管血流速度，PEO组均高于NS组（P〈O．05）。T一时PEO组和NS组HA阻力指数（PI）均较T。时显著增高，两组T2时PI均较T1时有所降低，但仍显著高于T。时（P〈O．05）。PEO组和Ns组TNF—n表达水平在Tl时和Tz时均持续升高，但组间比较无显著性差异（P〉0．05）。【结论】小剂量聚环氧乙烷能够明显提高感染休克时肝脏的血流灌注，但对于早期肝脏损害及炎症反应并无明显改善作用。

[Objective] To explore the influence of polyethylene oxide（PEO） on hepatic hemodynamics and its protective effect on liver after septic shock. [Methods] Twenty healthy New Zealand white rabbits were randomly divided into NS group（ n 10） and PEO group（ n 10）. Fasting lasted for 12h. Septic shock was caused by intravenous injection of endotoxin 0. 6mg/kg. In PEO group, normal saline solution with 50ppm PEO was used for resuscitation. In NS group, normal saline was used for resuscitation. Both dosages were 5mL/h/kg. Blood flow velocity of hepatic portal vein（PV） and hepatic artery（HA） and inflammatory cyto kines at shock prophase （T0）, shock phase （T1） and 2h after recovery （Tz） were compared between two groups. [[Results] Compared with T1, blood pressure at T2 in two groups was further decreased（ P〈0.05）, but blood pressure at T2 in PEO group was significant higher than that in NS group（ P〈0.05）. Blood flow velocity maximum（Vmax） and minimum velocity（Vmin） of PV and HA at T in PEO group were higher than those at T1 （ P〈0.05）, but still lower than those at To （ P〈0.05）. After resuscitation. PVmax in NS group was further decreased（ P〈0.05）, while PVmin, HAVmax and HAVmin were increased（ P 〈0.05）, but still obviously lower than those at To （ P 〈0.05）. Blood flow velocity of blood vessels in PEO group after re suscitation was higher than that in NS group（ P〈0.05）. Compared with TO, resistance index（PI） of HA at T; in both groups was significantly increased. Compared with T1, PI at T2 in both groups was decreased, but still higher than that at TO（ P 〈0.05）. The expression of TNFa in both groups was continuously increased at T. and Tz, but there was no significant difference between two groups（ P〈0.05）. [Conclusion] A small dose of polyethylene oxide can significantly improve the liver perfusion of rabbits with septic shock, but has no ob vious improvement effect on the early liver damage and inflammatory response.