促甲状腺素释放激素对犬肺挫伤合并休克的治疗作用

Therapeutic effect of thyrotropin releasing hormone on pulmonary contusion and hemorrhagic shock

目的 研究促甲状腺素释放激素 (TRH)在不依赖容量复苏的条件下对肺挫伤合并失血性休克动物的治疗作用。 方法 用BIM -II型生物撞击机致伤犬、兔右肺中上叶 ,然后经动脉放血 ,使平均动脉压 (MAP)降至 8.0kPa (6 0 .0mmHg) ,犬维持 30min ,兔维持 6 0min ,并给予TRH 5mg kg静脉注射 ,观察不同时相点犬血流动力学、磷酸肌酸激酶同工酶 (CK -MB)、呼吸功能、血气、肺分流率、心肺病理形态改变 ,以及兔血浆、挫伤肺内一氧化氮 (NO)、内皮素 (ET)、NO ET及血管紧张素转换酶 (ACE)的变化规律。 结果 (1)TRH治疗肺挫伤合并休克可明显地加强心肌收缩力 ,改善心脏功能及血流动力学 ,降低血浆中CK -MB作用 ,从而有效地抵抗休克。 (2 )TRH在该条件下使用可改善呼吸功能 ,减轻低氧血症及缓解酸中毒。 (3)TRH本身不收缩肺血管 ,不加剧肺动脉高压 ,不加重肺水肿及出血。 (4)TRH治疗后血浆及挫伤肺组织NO ET比值显著升高 ,ACE显著降低 ,证明TRH的作用与提高血浆及挫伤肺NO ET比值及保护肺血管内皮细胞有一定的关系。 结论 TRH用于肺挫伤合并休克有明显的抗休克作用 ,它能改善心肺功能而不加重肺出血水肿 ,提示TRH是一种救治肺挫伤合并休克较为理想的药物。

Objective To study the effect of thyrotropin releasing hormone (TRH) on pulmonary contusion (PC) and hemorrhagic shock in dogs and rabbits. Methods The model of PC was made through the right chest impact by BIM type bioimpact machine and shedding blood from femoral artery. Results 1.TRH had beneficial effect on PC without fluid replacement by enhancing myocardial contractility and improving cardiac function and hemodynamics. 2. TRH could improve pulmonary function and relieve hypoxemia and metabolic acidosis. 3. TRH alone did not cause pulmonary edema and bleeding. 4. NO/ET ratio in plasma and contusion tissue in the TRH group was much higher than that in the control group, but ACE in the TRH group was less than that in the control group. Conclusions TRH has significant therapeutic effect on PC and hemorrhagic shock. TRH therapeutic effect is probably related to its modulating NO/ET ratio of plasma and contusion tissue and protecting endothelial cells of pulmonary blood vessels. Presumably TRH has its advantages in treatment of the patients with PC and shock clinically .