丙酮酸盐透析液腹腔复苏对失血性休克大鼠肝损伤的影响

Effect of peritoneal resuscitation with pyruvate-based peritoneal dialysis solution on liver injury in a rat model of hemorrhagic shock

目的评价丙酮酸盐透析液腹腔复苏对失血性休克大鼠肝损伤的影响。方法健康雄性SD大鼠50只，体重200～250g，于10min内以0．6ml／min的速率抽取左股动脉血，使MAP降至30～40mmHg，并通过不断地抽出或网输自体血维持该水平60min，制备失血性休克模型。采用随机数字表法将大鼠分为5组（n=10）：假手术组（SH组）仅行手术操作，不抽血和复苏；常规静脉复办组（CVR组）失眦性休克模型制备成功后，经右股静脉凹输自体血以及2倍失血造的生理盐水进行复苏；生理盐水腹腔复苏组（Ns组）、乳酸盐透析液腹腔复苏组（LA组）和内酮酸盐透析液腹腔复苏组（PY组）住常规静脉复苏同时，分别腹腔输注生理盐水、2．5％葡萄糖乳酸盐腹膜透忻液、2．5％葡绚槠丙酮酸盐腹膜透析液20ml进行复苏，自体血和复苏液体输注时间均勾30min。f-放血前、休范5、30、60min、复苏结束后5、30、60、90、120min时记录MAP。复苏结束后120rain时采用化学比色法检测动脉帆乳酸浓度，然后处死大鼠，取肝组织，光镜下观察病理学改变，并行肝损伤评分。结果与放血前比较，CVR组、NS组、LA组和PY组休克期间MAP降低，复苏后各时点MAP升高（P〈0．05）。与SH组比较，CVR组、NS组、IA组和PY组休克期间和复苏后符时点MAP降低，动脉血乳酸浓度和肝损伤评分升高（P〈0．05）；与CVR组和NS组比较，LA组和PY组动脉血乳酸浓度和肝损伤评分降低（P〈0．05）；CVR组和NS组动脉m乳酸浓度和肝损伤评分比较差异无统计学意义（P〉0．05）；OLA组比较，PY组动脉血乳酸浓度和肝损伤评分降低（P〈0．05）。结论丙酮酸盐透析液腹腔复苏町减轻失血性休克大鼠肝损伤。

Objective To evaluate the effect of peritoneal resuscitation （PR） with pyruvate-based peritoneal dialysis solution （PDS） on liver injury in a rat model of hemorrhagic shock. Methods Fifly heahhy male Sprague-Dawley rats, weighing 200-250 g, were used in this study. The animals were anes- thetized with pentobarbital sodium, tracheostomized and mechanically ventilated, ttemorrhagic shock was induced by withdrawing blood from the left femoral artery at a rate of 0.6 ml/min within 10 rain until mean arterial pressure （MAP） was reduced to 30-40 mmHg which was maintained for 60 rain. The animals were divided into 5 groups （n = 10 each） using a random number table： sham operation group （group S t l） , conventional IV resuscitation group （group CVR）, PR with normal saline group （group NS）, PR with laeta/e-l）ased PDS grnup （group LA） and PR with pyruvate-based PDS group （group PY）. The animals only underwent surgical proeedure in group SH. In group CVR, the animals were resuscitated with infusion of the blood withdrawn and normal saline （the volume was 2 times volume of blood loss） via the righl femoral artery after successful establishment of hemorrhagic shock. In NS, LA and PY groups, conventional re- suscitation was performed, and the animals were simultaneously resuscitated with normal saline, 2.5% glu- cose-based PDS containing lactate, and 2.5% glucose-based PDS containing pyruvate 20 ml, respectively. The blood withdrawn and fluid for resuscitation were all infused over 30 rain. MAP was recorded before blood letting, at 5, 30 and 60 min of shock and at 5, 30, 60, 90 and 120 min after the end of resuscita- tion. The arterial blood lactate level was measured by chemical colorimetry at 120 min after the end of resus- citation. The animals were then sacrificed and livers were removed for examination of the pathological chan- ges with a light microscope. The damage to livers was assessed and scored. Results Compared with MAP before blood letting, MAP was significantly decreased during hemorrhagic shock and increased at each time point after resuscitation in CVR, NS, LA and PY groups （P〈0.05）. Compared with group SH, MAP during hemorrhagic shock and at each time point after resuscitation was significantly decreased, and the ar- terial blood lactate level and liver damage scores were increased in CVR, NS, LA and PY groups （P〈 0. 05）. Compared with CVR and NS groups, the arterial blood lactate level and liver damage scores were significantly decreased in LA and PY groups （P〈0. 05）. There was no significant difference in the arterial blood lactate level or liver damage scores between group CVR and group NS （P〉0.05）. Compared with group LA, the arterial blood lactate level and liver damage scores were significantly decreased in group PY （ P〈0. 05）. Conclusion PR with pyruvate-based PDS can reduce liver injury in a rat model of hemorrhag- ic shock.