失血性休克大鼠高渗氯化钠溶液复合生脉注射液复苏后对氧化应激损伤的影响

Effects of hypertonic saline combined with Shengmai injection on oxidative injury in rat with hemorrahagic shock after resuscitation

目的观察生脉注射液复合高渗氯化钠溶液对失血性休克大鼠血流动力学、小肠组织结构形态、氧化应激指标的影响。方法采用Wiggers改良法制备失血性休克大鼠模型,Sprague-Dawley大鼠随机分为3组,每组10只。组Ⅰ(失血性休克组),除经颈静脉滴注0.9%氯化钠溶液2mL·kg-1·h-1以补充生理性体液丢失外,不补充其他任何液体;组Ⅱ(高渗氯化钠溶液组),静脉滴注7.5%高渗氯化钠溶液(6mL/kg);组Ⅲ(生脉注射液加高渗氯化钠溶液组),将生脉注射液(2.84g生药/kg)溶入7.5%高渗氯化钠溶液(6mL/kg)中静脉滴注。应用多参数生理记录仪记录大鼠复苏结束后每隔30min的平均动脉压(MAP)和心率(HR)的变化,测定复苏前后的血清超氧化物歧化酶(SOD)活性及丙二醛(MDA)水平。采用Chiu氏分级法半定量观察各组大鼠小肠组织的形态变化,比较各组大鼠小肠黏膜的损伤程度。结果各组大鼠的基础和休克后的MAP和HR的差异均无统计学意义(P值均>0.05)。在治疗后的各时间点,组Ⅱ、Ⅲ的MAP和HR均显著高于组Ⅰ(P值均<0.01),而组Ⅱ与组Ⅲ间的差异均无统计学意义(P值均>0.05)。组Ⅰ大鼠的小肠黏膜绒毛水肿、大片状缺损,固有膜水肿并伴有炎性细胞浸润;组Ⅱ、Ⅲ大鼠小肠黏膜绒毛结构完整,有轻度水肿,固有膜无水肿及炎性细胞浸润。组Ⅰ3级以上损伤的构成比为10/10,显著高于组Ⅱ、Ⅲ的3/10和1/10(P值均<0.05)。复苏后,组Ⅰ的血清SOD水平显著低于基础值(P值均<0.05),而组Ⅱ、Ⅲ与基础值的差异无统计学意义(P值均>0.05);组Ⅱ、Ⅲ的血清SOD水平均显著高于组Ⅰ(P值均<0.05)。复苏后,组Ⅰ的血清MDA水平显著高于基础值(P<0.05),而组Ⅱ、组Ⅲ与基础值的差异无统计学意义(P值均>0.05);组Ⅱ、Ⅲ的血清MDA水平均显著低于组Ⅰ(P值均<0.05)。结论高渗氯化钠溶液复合生脉注射液能有效改善失血性休克大鼠模型的血流动力学和小肠组织的损伤程度,同时可显著减轻复苏后的氧化应激损伤。

Objective To observe the effects of Shengmai injection combined with hypertonic saline on hemodynamics, intestinal histopathologic changes and oxidative stress in rats with hemorrhagic shock. Methods Thirty Sprague-Dawley rats were prepared for hemorrhagic shock according to modified Wiggers method and then randomly divided into 3 groups （n =10）. Normal saline （2mL·kg^-1·h^-1 ） was given by jugular drop infusion in group Ⅰ . Group Ⅱreceived 7.5% hypertonic saline （6 mL/kg）, and group Ⅲ received Shengmai injection （raw drug 2.84 g/kg） and 7.5% hypertonic saline （6 mL/kg）. Mean arterial pressure （MAP） and heart rate （HR） were recorded with a multi-parameter monitor every 30 minutes after resuscitation. The levels of serum superoxide dismutase （SOD） and malondialdehyde （MDA） were determined before and after resuscitation. The intestinal morphologic changes were semiquantitatively observed by Ohiu＇s classification scheme and the injury of mucous membrane were compared between groups. Results There were no significant differences in MAP or HR amonggroups before and during shock （all P〉0. 05）. After resuscitation, MAP and HR in groups Ⅱ and Ⅲ were significantly higher than those in group Ⅰ（all P〈0.01）, but there was no statistical difference between group Ⅱ and group Ⅲ（all P〉0.05）. Under microscope, we found that there were edema and large defect of intestinal mucosa villus and edema and inflammatory infiltration of intrinsic membrane in group Ⅰ , but in groups Ⅱ and Ⅲ villus was intact and there was mild edema in villus and no edema and inflammatory infiltration of intrinsic membrane. The intestinal injury severity score over grade 3 was significantly higher than that in group Ⅱ and Ⅲ （10, 3, and 1, both P〈0. 05）. After injection, SOD was significantly decreased and MDA was significantly increased in group Ⅰ（both P〈0.05）, while they remained unchanged in both group Ⅱ and group Ⅲ （all P〉 0.05）. There were significant differences in SOD and MDA between group Ⅰ and groups Ⅱ and Ⅲ （all P〈0.05）. Conclusion Shengmai injection combined with hypertonic saline can effectively improve the hemodynamics and intestinal injury in the rats suffering from hemorragic shock, and significantly reduce the oxidative stress after recovery.