静脉复苏辅助腹腔注射高渗液对感染性休克大鼠的治疗效果

Therapeutic effect of adjunct peritoneal resuscitation in septic shock rats

目的探讨静脉复苏辅助腹腔注射高渗液对感染性休克大鼠的治疗作用。方法感染性休克模型SD雄性大鼠36只,随机均分为三组,分别行单纯静脉复苏(A组)、静脉复苏辅助腹腔注射生理盐水(B组)和腹腔注射高渗液(C组)。静脉复苏采用复方乳酸钠25ml/kg快速静脉输注30min,随后B组腹腔注入生理盐水100ml/kg,C组腹腔注入等量2.5%葡萄糖低钙腹膜透析液。观测大鼠血流动力学变化,测定复苏前后TNF-α与IL-6的含量及复苏后2h动脉血气。复苏后20h观察大鼠存活情况并解剖观察其内脏改变。结果静脉复苏结束至复苏后2h,C组MAP无明显变化,A、B组MAP逐渐下降,复苏后2hC组MAP显著高于A、B组(P<0.05)。复苏后2h,C组pH、HCO-3、BE、BEcef值明显高于A、B组,乳酸浓度明显低于A、B组(P<0.05或P<0.01)。复苏前0.5h、复苏后1、2h三组血清TNF-α和IL-6含量均明显高于基础值(P<0.01)。复苏后1、2hC组血清TNF-α、IL-6含量明显低于A、B组(P<0.05或P<0.01)。复苏后20h,A组有7只(58%)大鼠存活,B组有9只(75%),C组有10只(83%),三组存活率差异无统计学意义。结论静脉复苏辅助腹腔注射高渗液对感染性休克大鼠多项复苏指标的恢复能够产生积极的影响,从而改善感染性休克大鼠的复苏治疗效果。

Objective To study the therapeutic effect of adjunct peritoneal resuscitation in septic shock rats. Methods Septic rats induced by LPS were randomly assigned to one of three treatment groups （n = 12 each）, group A received only intravenous fluid resuscitation with lactate Ringer＇s solution （25 ml/kg） for 30 minutes, group B received intravenous resuscitation together with intraperitoneal normal saline 100 ml/kg, group C received intravenous resuscitation plus intraperitoneal resuscitation with dialysis solution 100 ml/kg. After resuscitation, the hemodynamic changes were observed. The serum concentrations of inflammatory mediators were detected before and 2 hours after resuscitation. The survival rates and the morphological changes of visceral organs were also investigated. Results Compared with groups A and B, the mean arterial blood pressure levels of septic rats in group C were restored and stabilized. The arterial levels of pH, HCO3- and BE were increased, the concentration of arterial lactate, TNF-α and IL-6 were reduced, the morphological changes of visceral organs were reduced and the survival rates of septic shock rats were increased by adjunct intraperitoneal resuscitation. Conclusion Adjunct peritoneal hypertonic fluid resuscitation can provide a positive impact on fluid resuscitation in septic shock rats.