连续性血液透析滤过联合参麦注射液对MODS犬的脏器保护作用

Organ Protective Effect of Combined Therapy of Shenmai Injection and Continous veno-venous haemodiafiltration on dogs with multiple organ dysfunction syndrome

目的探讨连续性血液透析滤过(CVVHDF)联合参麦注射液(SMI)对多器官功能障碍(MODS)犬的脏器保护作用。方法2012年9月—2013年4月进行实验研究,采用失血性休克+复苏灌注+内毒素血症建立MODS模型,30只成年Mongrel犬随机分为MODS组、CVVHDF组及CVVHDF+SMI组。CVVHDF组内毒素注射后给予CVVHDF治疗;CVVHDF+SMI组同时给予参麦注射液,1.5 m L/Kg体重,2次/d;MODS组做常规治疗。在不同的时间段,分别对肌酐(Cr)、血清丙氨酸转氨酶(ALT)、尿素氮(BUN)、天冬氨酸转氨酶(AST)的含量进行检测,并在治疗5 d后取肝、肾组织行病理组织学检查。结果MODS模型制备成功后,血清BUN、Cr、ALT和AST含量明显升高,与正常犬相比,差异有统计学意义(P<0.01);CVVHDF及CVVHDF+SMI组治疗1 d后,血清BUN、Cr水平开始下降,显著低于同时间点MODS组(P<0.01或P<0.05);治疗3 d后,CVVHDF+SMI组血清BUN、Cr水平显著低于CVVHDF组(P<0.01或P<0.05)。各组血清ALT、AST水平在治疗3 d后均开始下降,治疗第3 d、4 d、5 d,各组间血清ALT、AST水平差异有统计学意义(P<0.01或P<0.05)。镜下可见:MODS犬肾小球体积增大,细胞增生、肿胀,肾小管细胞变性、坏死,髓质区可见梗死灶;肝脏可见灶状与大片状坏死、出血,伴炎症细胞浸润;汇管区血管扩张淤血,枯否氏细胞多见。CVVHDF组肝、肾组织损伤明显减轻,CVVHDF+SMI组肝、肾组织损伤程度最轻。结论连续性血液透析滤过能减轻MODS犬的脏器组织损伤,参麦注射液与之联用脏器保护作用更佳。

Objective To investigate the organ protective effect of combined therapy of Shenmai injection（SMI） and continous veno-venous haemodiafiltration（CVVHDF） on dogs with multiple organ dysfunction syndrome（MODS）. Methods 30 Mongrel dogs were subjected to hemorrhagic shock plus resuscitation and endotoxemia to set up MODS model, then were randomly divided into3 groups： MODS, CVVHDF and CVVHDF＋SMI groups. CVVHDF was performed 5 days after endotoxin injection was finished in CVVHDF group. SMI group received intravenous injection of SMI（1.5ml/Kg, Bid）. The serum levels of alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, blood urea nitrogen（BUN） and creatinine（Cr） were detected. Histopathological changes of liver and kidney were observed after 5-days treatment. Results The serum levels of BUN, Cr, ALT and AST in MODS group are much higher than control dogs（P0.01）.The serum levels of BUN and Cr in CVVHDF and CVVHDF＋SMI groups begin to decrease after 1 day of treatment, which were significantly lower than those in MODS group at the same time points（P0.01 or P0.05）. At3-days after treatment the serum levels of BUN and Cr in CVVHDF＋SMI group were much lower than those in CVVHDF group（P0.01 or P0.05）.At the same time, the serum levels of ALT and AST begin to decrease in all of groups, and the serum levels of ALT and AST were significantly different between the groups at 3-, 4- and 5-days of treatment（P0.01 or P0.05）. The renal in MODS dogs showed glomerular volume increased, glomerular cell proliferation and swelling, degeneration and necrosis of the renal tubular cell, infarction in medulla. The liver in dogs with MODS showed spotty necrosis, hemorrhage, inflammatory cell infiltration,periportal congestion and vasodilation. Kupffer cells were much more than control dogs. The damage of liver and kidney was significantly milder in CVVHDF group than MODS dogs, and the pathology of the liver and kidney was nearly normal in CVVHDF＋SMI group. Conclusion The organ protective effect of CVVHDF combined with SMI on dogs with are much better than SMI only.