限制性液体复苏对创伤未控制失血性休克大鼠肝脏的保护作用

Protective effect of limited fluid resuscitation on the liver injury in rats with severe uncontrolled hemorrhagic shock

目的探讨早期限制性液体复苏对重度创伤未控制失血性休克大鼠肝脏是否具有保护作用。方法创伤未控制失血性休克SD大鼠模型，随机分成假手术组（SS）、未输液组（NF）、大量液体复苏组（AR）、和限制性液体复苏组（LR），分别于30min、90min、150min、270min、510min五个时间点每组取四只大鼠采血检测血清ALT水平；同时处死大鼠取肝组织，采用HE染色观察大鼠肝组织的病理改变。结果各组大鼠休克后，血清ALT／AST均开始升高。急救期给予不同方式处理后，随着时间的延长，NF、AR、LR三组大鼠血清的ALT／AST均进行性升高。其中以NF组升高最明显，LR组变化较小。肝组织光镜下的病理改变主要表现为肝细胞水肿和脂肪变性。实验过程中NF和AR组比LR组损伤更明显。结论手术前早期限制性液体复苏有利于创伤未控制失血性休克大鼠肝脏功能的保护，避免多器官功能的衰竭，可能为临床创伤未控制失血性休克早期救治提供一个较好复苏方案。

Objective To investigate the protective effect of the limited fluid resuscitation on liver injury in rats with severe uncontrolled hemorrhagic shock. Methods The injured rats which received no treatment were randomly divided into four groups, sham surgery group （SS group）, no fluid resuscitation group （NF group）, aggressive fluid resuscitation group （AR group） and limited fluid resuscitation group （LR group）. The value of serum ALT of every group were detected and compared at 30, 90, 150, 270, 510 minutes and pathologic changes of hepatic tissue were observed with hematoxylin and eosin （HE） dyeing. Results The value of ALT in NF, AR, and LR group continuously increased with experimental time prolonged after dealt with different fluid resuscitation in traumatic emergency phrase, with the highest level in NF group and the lowest in LR group. The hepatic tissue＇ s pathologic change in NF and AR groups was more obvious than that in LR group during the whole process. Conclusion The earlier limited fluid resuscitation is effective to protect hepatic function of rats after severe traumatic uncontrolled hemorrhagic shock and may avoid MODS, which may be an ideal curative method for clinical severe traumatic uncontrolled hemorrhagic shock.