口服丙酮酸盐糖液对致死性失血性休克大鼠脏器功能及存活率的影响

Effects of oral pyruvate-glucose-electrolyte solution on organ function and survival in resuscitation oflethal hemorrhagic shock rats

目的研究和比较口服丙酮酸钠-葡萄糖-电解质液（PGES）与碳酸氢钠．葡糖糖一电解质液（BGES）对致死性失血性休克大鼠的复苏效果。方法60只成年雄性SD大鼠行胃造瘘置管及左侧股、动静插管后经股动脉按45％TBV（全身血容量）放血后，按随机数字法分为三组（每组20只）：不复苏组（NR组），口服丙酮酸盐糖液组（PGES组）和口服碳酸氢盐糖液组（BGES组）。NR组不接受任何液体或药物治疗；PGES组和BGES组于失血后30min开始经胃造瘘管采用微量泵6h内匀速输入2倍失血量提前预热的PGES或BGES。失血前，失血后0、1、2、4h取血测定血清谷丙转氨酶（ALT）、肌酐（cr）、磷酸肌酸激酶同工酶（CK—MB）和肠脂肪酸结合蛋白（iFABP）指标。另84只大鼠随机分为NR组（n=24）、PGES组（n=24）、BGES组（n=24）和手术后不放血对照组（NH，n=12），各休克组处理同前，NH组行胃造瘘及动静脉置管术但不放血，分别观察各组动物存活时间并进行24h生存分析。结果PGES组和BGES组大鼠的24h存活率显著高于NR组（11／24VS．1／24，X2=18．087，P〈0．01；5／24VS．1／24，X2=6．445，P〈0．05），且PGES组24h存活率显著高于BGES组（11／24VS．5／24，X2=4．02，P〈0．05）。脏器功能观察中NR及两口服补液组失血休克后1、2、4h的指标：ALT、CK．MB、Cr和iFABP均分别显著高于失血前水平（P〈0．01）；失血后2h和4h时间点PGES和BGES组的以上所有指标均分别显著低于NR组（P〈0．01），且PGES组明显低于BGES组（P〈0．05）。结论口服含丙酮酸盐的ORS液（PGES）在改善致死性失血性休克大鼠的脏器功能指标及延长动物生存的效果优于含碳酸氢盐的ORS液（BGES）。WHO推荐的ORS液有望得到进一步改良，丙酮酸盐糖液有可能成为无静脉复苏条件下救治致死性失血休克的首选口服补液盐。

Objective To study the effects of oral rehydration with the solution of pyruvate-glucose- electrolyte （PGES） by comparison with the bicarbonate-glucose-electrolyte solution （BGES） on resuscitation in rats with lethal hemorrhagic shock. Methods Sixty adult male SD rats with intra-gastric tube, and cannulation of femoral artery and vein were subjected to 45% total blood volume loss from the femoral artery, and then randomly divided into three groups （n = 20 in each group） ： no fluid resuscitation group （NR）, oral fluid resuscitation with the PGES group （PGES） and oral fluid resuscitation with the BGES group（BGES）. In NR group, the animals received no fluid replacement or any other treatment. Rats in PGES and BGES groups were infused intra-gastrically with pre-warmed PGES or BGES in volume of 2 times shed blood given at 30 min after hemorrhage and completed within 6 hours. Blood samples in each group were collected from the abdominal aorta before or at 0, 1,2, 4 h post hemorrhage to detect serum alanine aminotransferase （ALT） , creatinine （Cr）, creatine phosphate kinase isoenzyme （CK-MB） and intestinal fatty acid binding protein （iFABP）. Another 84 rats randomly divided into four groups ： NR group （ n -- 24）, PGES group （ n =24）, BGES group （n = 24）, and no hemorrhage group （NH group, n = 12）. Rats in the three hemorrhage groups were treated the same as described above, and the rats in NH group underwent the same surgical procedure without hemorrhage were served as the sham group. All these rats were observed for their 24-hour survival rates. Results The 24-hour survival rates of PGES and BGES groups were both significantly higher than the rate of NR group （11/24 vs. 1/24, X2 = 18. 087, P 〈0. 01 ; 5/24 vs. 1/24, X2 = 6. 445, P 〈 0. 05 ） ; the survival rate of PGES group was also significantly higher than that of BGES group （ 11/24 vs. 5/24, x2= 4. 02, P 〈 0. 05）. All levels of ALT, CK-MB, Cr and iFABP in both the NR group and two oral resuscitation groups at 1 h, 2 h and 4 h post hemorrhage were significantly higher than those before the blood loss, respectively （P 〈 0. 01 ）. These biomarkers at 2 h, 4 h post hemorrhage were significantly lower in the PGES and BGES groups than those in NR group （ P 〈 0. 01 ） ; the serum levels of ALT, CK-MB, Cr and iFABP were significantly lower in the PGES group than those in the BGES group at 2 h and 4 h post hemorrhage, respectively （ P 〈 0. 05 ）. Conclusions Present results demonstrated that the pyruvate-enriched oral re-hydration solution （ ORS = PGES） was more effective in preserving the organ function and prolonging the animal survival after resuscitation of lethal hemorrhagic shock in comparison with the bicarbonate-containing ORS （BGES）. The oral re-hydration solution （PGES） recommended by the World Hygiene Organization （WHO ORS） may require further improvement in oral resuscitation of shock and the PGES may be recommended as a choice of oral re-hydration salts in the treatment of lethal hemorrhagic shock when intravenous administration is not available.