丙酮酸盐腹膜透析液腹腔复苏对失血性休克大鼠肾损伤的影响

Effect of peritoneal resuscitation with pyruvate-based a rat model of hemorrhagic shock

目的 评价丙酮酸盐腹膜透析液腹腔复苏对失血性休克大鼠肾损伤的影响。方法 健康成年雄性SD大鼠50只，体重200～250 g，8周龄，采用随机数字表法分为5组（n＝10）：假手术组（SH组）、常规静脉复苏组（VR组）、生理盐水腹腔复苏组（NS组）、乳酸盐腹膜透析液腹腔复苏组（LA组）和丙酮酸盐腹膜透析液腹腔复苏组（PY组）。采用经左股动脉放血，10 min左右使MAP降至30～40 mmHg并维持该水平1 h的方法制备失血性休克模型。VR组于休克后1 h静脉回输失血及2倍失血量的生理盐水行静脉复苏；NS组、LA组和PY组行静脉复苏的同时分别采用生理盐水、乳酸盐腹膜透析液和丙酮酸盐腹膜透析液20 ml行腹腔复苏，输注时间30 min。复苏后180 min时取肾脏组织，光镜下观察病理学结果，进行肾小管损伤评分，检测肾组织丙二醛（MDA）含量、髓过氧化物酶（MPO）活性及超氧化物岐化酶（SOD）活性。结果 与SH组比较，其它4组肾小管损伤评分、MDA含量和MPO活性升高，SOD活性降低（P〈0.05）；与VR组比较，NS组、LA组和PY组肾小管损伤评分、MDA含量和MPO活性均降低，SOD活性升高（P〈0.05）；与NS组或LA组比较，PY组肾小管损伤评分、MDA含量和MPO活性均降低，SOD活性升高（P〈0.05）。PY组肾组织病理学损伤明显轻于VR组、NS组和LA组。结论 丙酮酸盐腹膜透析液腹腔复苏可减轻失血性休克大鼠肾损伤。

Objective To evaluate the effect of peritoneal resuscitation（PR）with pyruvate-based peritoneal dialysis solution（PDS）on kidney injury in a rat model of hemorrhagic shock.Methods Fifty healthy adult male Sprague-Dawley rats, weighing 200-250 g, aged 8 weeks, were divided into 5 groups（n=10 each）using a random number table： sham operation group（group SH）, conventional IV resuscitation group（group VR）, PR with normal saline group（group NS）, PR with lactate-based PDS group（group LA）and PR with pyruvate-based PDS group（group PY）. Hemorrhagic shock was induced by withdrawing blood from the left femoral artery at a rate of 0.6 ml/min about 10 min until mean arterial pressure was reduced to 30-40 mmHg which was maintained for 1 h. In group VR, the animals were resuscitated with infusion of the blood withdrawn and normal saline（the volume was 2 times volume of blood loss）at 1 h after hemorrhagic shock.In NS, LA and PY groups, conventional IV resuscitation was performed, and the animals were simultaneously resuscitated with normal saline, lactate-based PDS, and pyruvate-based PDS 20 ml infused intraperitoneally over 30 min, respectively.The animals were sacrificed at 180 min after resuscitation, and kidneys were removed for examination of the pathological changes（with a light microscope）and for measurement of the content of malondialdehyde（MDA）and activities of myeloperoxidase（MPO）and superoxide dismutase（SOD）in renal tissues.The damage to renal tubules was assessed and scored.Results Compared with group SH, the renal tubular damage scores, MDA content and MPO activity were significantly increased, and the activity of SOD was decreased in the other four groups（P〈0.05）. Compared with group VR, the renal tubular damage scores, MDA content and MPO activity were significantly decreased, and the activity of SOD was increased in NS, LA and PY groups（P〈0.05）. Compared with group NS or group LA, the renal tubular damage scores, MDA content and MPO activity were significantly decreased, and the activity of SOD was increased in group PY（P〈0.05）. The pathological changes of renal tissues were significantly attenuated in group PY when compared with VR, NS and LA groups.Conclusion PR with pyruvate-based PDS can reduce kidney injury in a rat model of hemorrhagic shock.