7.5%高渗盐水对失血性休克患者炎性因子及氧自由基的作用

Effect of 7. 5% hypertonic saline on inflammatory factors and oxygen free radicals in patients with hemorrhagic shock shock

目的探讨7.5%高渗盐水对失血性休克患者促炎因子、抗炎因子以及氧自由基的影响与意义。方法将大连大学附属中山医院急诊医学科2009年5月至2012年10月收治的失血性休克患者45例,随机分为常规复苏组(对照组,22例)和高渗盐水组(试验组,23例)。对照组采用常规液体复苏,高渗盐水组患者在对照组基础上加用7.5%高渗盐水300 ml。观察两组患者入院时(T0)、用药后1 h(T1)、2 h(T2)、6 h(T3)、12h(T4)五个时间点心率、平均动脉压、呼吸频率、血乳酸、二氧化碳结合力变化,并抽取静脉血采用酶联免疫吸附测定法(ELISA)法检测血清促炎因子(TNF-α、IL-1)、抗炎因子(IL-10)以及超氧化物歧化酶(SOD)活性、丙二醛(MDA)浓度。应用SPSS 14.0软件t检验对数据进行统计学分析。结果与各组入院时相比,用药后1、2、6和12 h血清促炎因子TNF-α、IL-1水平均有不同程度升高,IL-10则下降。与对照组同时间点相比,试验组TNF-α从1 h即开始降低(8.56±1.35)pg/ml,(11.56±1.68)pg/ml,t=2.024,P<0.05,2、6和12 h降低更显著(2 h:10.18±1.56)pg/ml,(19.36±2.21,t=2.97)pg/ml,6 h:(15.59±1.56)pg/ml,(29.2±3.24)pg/ml,t=3.02,12 h:(18.94±1.98)pg/ml,(30.79±3.65)pg/ml,t=5.072,均P<0.01);IL-1在高渗盐水治疗后2、6和12 h显著降低(6.63±0.72)pg/ml,(8.43±0.84)pg/ml,t=2.116,P<0.05;6 h:(7.21±0.78)pg/ml,(12.5±1.02)pg/ml,t=4.402,12 h:(9.49±0.87)pg/ml,(15.44±1.57)pg/ml,t=6.221,均P<0.01);IL-10含量在2、6、12 h有明显升高趋势2 h:(10.03±0.74)pg/ml,(8.46±0.62)pg/ml,t=1.982,P<0.05;6 h:(9.58±0.68)pg/ml,(7.21±0.55)pg/ml,t=2.977,12 h:(9.21±0.61)pg/ml,(5.76±0.47)pg/ml,t=2.582,均P<0.01。与对照组相比,实验组1、2、6和12h血清MDA明显降低,差异有统计学意义1 h:(4.35±0.67)pg/ml,(7.56±0.94)pg/ml,t=1.974,P<0.05;2 h:(6.58±0.84)pg/ml,(11.39±1.36)pg/ml,t=2.118,6 h:(8.41±1.14)pg/ml,(16.87±2.17)pg/ml,t=5.691,12 h:(8.39±1.15)pg/ml,(15.42±2.08)pg/ml,均P<0.01,而SOD下降趋势明显减弱1 h:(114.86±7.62)pg/ml,(102.45±6.79)pg/ml,t=1.968,2h:(106.51±6.68)pg/ml,(91.44±6.82)pg/ml,t=2.034,均P<0.05;6 h:(98.24±7.68)pg/ml,(74.45±6.27)pg/ml,t=3.230,12 h:(90.15±7.92)pg/ml,(64.31±5.45)pg/ml,t=4.368,均P<0.01。试验组患者心率、平均动脉压、呼吸频率、血乳酸、二氧化碳结合力均有不同程度改善,差异有统计学意义(P<0.05)。结论高渗盐水能通过降低失血性休克患者促炎因子TNF-α、IL-1的释放,提高抗炎因子IL-10含量,减少氧自由基形成,减少脂质过氧化。

Objective To study the role and significance of 7.5% hypertonic saline on proinflammatory/anti-inflammatory factor and oxygen free radicals in patients with hemorrhagic shock. Methods Forty five cases with hemorrhagic shock,from Emergency Medicine Department,Affiliated Zhongshan Hospital of Dalian University in May 2009 to June 2012,were randomly divided into conventional resuscitation groups（control group,n =22）and hypertonic saline group（treatment group,n =23）.The control group was used conventional liquid recovery,the hypertonic saline group added 300 ml with 7.5%hypertonic saline on the basis of control group.To determine the change of heart rate,mean arterial pressure, breathing rate,blood lactic acid,carbon dioxide combining power,and TNF-α,IL-1,IL-10,superoxide dismutase （SOD）activity and malondialdehyde （MDA）arrived at hospital（T0 ）and after medication 1（T1 ）, 2（T2 ）,6（T1 ）and 12 h（T4 ）.Results Serum TNF-αin control group increased at 1,2,6,12 h in varying degrees compared with arrived at hospital.Compared with control group,TNF-αin experimental group start decreasing from 1 h （8.56 ±1.35）pg/ml,（11.56 ±1.68）pg/ml,t =2.024,P 〈0.05,and decreased obviously from 2 h to 12 h [2 h：（10.18 ±1.56）pg/ml,（19.36 ±2.21）pg/ml,t =2.97,6 h：（15.59 ±1.56）pg/ml, （29.2 ±3.24）pg/ml,t =3.02,12 h：（18.94 ±1.98）pg/ml,（30.79 ±3.65）pg/ml,t =5.072,P 〈0.01].IL-1were significantly decreased after using 2,6,12 h[2 h：（6.63 ±0.72）pg/ml,（8.43 ±0.84）pg/ml,t =2.116, P 〈0.05;6 h：（7.21 ±0.78）pg/ml,（12.5 ±1.02）pg/ml,t =4.402,12 h：（9.49 ±0.87）pg/ml,（15.44 ± 1.57）pg/ml,t =6.221,P 〈0.01].The content of IL -10 were significantly increased at 2,6,12 h [2h：（10.03 ± 0.74）pg/ml,（8.46 ±0.62）pg/ml,t =1.982,P 〈0.05;6 h：（9.58 ±0.68）pg/ml,（7.21 ±0.55）pg/ml,t =2.977,12 h：（9.21 ±0.61）pg/ml,（5.76 ±0.47）pg/ml,t =2.582,P 〈0.01].Compared with the control group, serum MDA decreased obviously experimental group 1,2,6,12 h[1 h：（4.35 ±0.67）pg/ml,（7.56 ±0.94）pg/ml,t =1.974,P 〈0.05;2 h：（6.58 ±0.84）pg/ml,（11.39 ±1.36）pg/ml,t =2.118,6 h：（8.41 ±1.14）pg/ml, （16.87 ±2.17）pg/ml,t =5.691,12 h：（8.39 ±1.15）pg/ml,（15.42 ±2.08）pg/ml,P 〈0.01],while SOD decline significantly diminished[1 h：（114.86 ±7.62）pg/ml,（102.45 ±6.79）pg/ml,t =1.968,2 h：（106.51 ± 6.68）pg/ml,（91.44 ±6.82）pg/ml,t =2.034,P 〈0.05;6 h：（98.24 ±7.68）pg/ml,（74.45 ±6.27）pg/ml,t =3.230,12 h：（90.15 ±7.92）pg/ml,（64.31 ±5.45）pg/ml,t =4.368,P 〈0.01].The patients′heart rate,MAP, breathing rate,blood lactic acid,carbon dioxide,binding force in treatment group are improved separately compared with control group（P 〈0.05）.Conclusion 7.5% hypertonic saline could reduce the release of TNF-αand IL-1,increase contents of IL-10,and inhibit of oxygen free radical formation,reduce lipid peroxidation.