限制性液体复苏对创伤未控制失血性休克大鼠机体保护作用的实验研究

The experimental study on the protective effect of limited fluid resuscitation on rats with 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的保护作用。方法将健康SD大鼠制成创伤未控制失血性休克大鼠模型,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),分别于实验的30、90、150、270、510min时间点采血检测血清ALT水平,并处死大鼠采用HE染色观察大鼠肝组织的病理改变,计算各组大鼠尾部继发性出血量、后续输液量、存活时间和存活率。结果 LR组大鼠尾部继发性出血量低于NF组和AR组(P<0.05);LR组大鼠后续治疗所需液量明显少于AR组和LR组(P<0.01);创伤急救期给予不同方式处理,各时间点不同组别ALT水平比较,LR组<AR组<NF组(P<0.05);肝组织病理学损伤:NF组和AR组比LR组损伤更明显;LR组大鼠存活时间长于NF组和LR组。LR组大鼠在150、270、510min和72h的存活率均高于NF组和AR组(生存分析P<0.01)。结论早期限制性液体复苏可减少创伤未控制失血性休克大鼠的继发性出血量和后续治疗输液量,有利于肝脏功能的保护,提高存活时间和存活率,可能为临床对重度创伤未控制失血性休克早期救治的较好治疗方案。

Objective To investigate the protective effect of the early limited fluid resuscitation rats with severe uncon- trolled hemorrhagic shock. Methods The model rats were randomly divided into four groups by the different fluid resuscitation means： the sham surgery group（SS） ,no fluid resuscitation group（NF） ,aggressive fluid resuscitation group（AR） and limited fluid resuscitation group（LR）. The value of serum ALl＇ of four rats in every group at 30min, 90rain, 150min, 270min, 510min were detected, the hepatic tissue＇ s pathologic changes was detected by hematoxylin and eosin （HE） dyeing. The loss volume of rat＇ s tail continuous blood, the resuscitation fluid volume, the survival time and the survival rate of the rats were analysied. Results During the experiment, tlae loss volume of tail continuous blood of LR group of rats is lower than NF and AR group （ P 〈 O. 05 ）, and the resuscitation fluid volume for LR group of rats is also lower than NF and AR group（ P 〈 0. 01 ）. After treatment with differ- ent fluid resuscitation in traumatic emergency phrase, the value of ALT in NF,AR,LR group rat＇s was continuously increased with highest degree in NF group and lowest degree in LR group. The hepatic tissue＇ s pathologic change of NF and AR group＇ s rat was severer than that of LR group during the whole process. ＇Pae rat＇ s survival time of LR group was significant longer than that of NI： and AR group（ P 〈0.01 ）, and the survival rate of LR group in every monitoring time point , such as 150min,270min ,510rain, 72h, was significant higher than that of NF and AR group. Conclusion After severe traumatic uncontrolled hemorrhagic shock, the earlier limited fluid resuscitation is effective to reduce the loss volume of tail continuous blood and the resuscitation fluid vol- ume, to protect hepatic function, to increase the survival time and tile survival rate of rats, which may be an ideal curative method for severe traumatic uncontrolled hemorrhagic shock. In clinical.