不同液体限制性复苏对失血性休克患者外周血炎症因子及动静脉血气的影响

Effects of different fluid restriction resuscitation on inflammatory factor and arteriovenous blood gas in patients with hemorrhage shock

目的探讨不同液体限制性复苏对创伤失血性休克患者外周血炎症因子及动静脉血气的影响,以期为临床治疗筛选相对理想的复苏液体提供依据。方法采用前瞻性对照研究。纳入2016年1月—2019年1月蚌埠医学院第一附属医院急诊外科收治的40例失血性休克患者,应用简单随机分组法分为观察组和对照组,各20例。观察组复苏液体采用醋酸钠林格液,对照组复苏液体采用乳酸钠林格液,复苏方法均采用限制性液体复苏;分别于开始复苏前、复苏30 min和复苏1 h后采集外周静脉、动脉和中心静脉血液样本,测定血清中白细胞介素(IL)-4、IL-6、γ干扰素(IFN-γ)、肿瘤坏死因子α(TNF-α)的水平,以及复苏前和复苏1 h后动脉血乳酸、动脉血氧饱和度、中心静脉血氧饱和度、动脉氧分压、静脉氧分压,通过比较两组患者外周血炎症因子水平及动静脉血气的变化,观察两种液体的复苏效果。结果两组患者复苏前的一般情况及IL-4、IL-6、IFN-γ、TNF-α差异均无统计学意义(P值均>0.05)。复苏30 min及1 h后,两组休克患者外周血炎症因子的表达水平均升高,除复苏后30 min至复苏后1 h之间IL-4和IFN-γ的升高幅度差异均无统计学意义外(P值均>0.05),余差异均有统计学意义(P值均<0.05)。通过对升高幅度的差值进行独立样本t检验可发现,与对照组相比,复苏后观察组患者炎症因子IL-6和TNF-α的释放减少,差异均有统计学意义(P值均<0.05),但两组患者IL-4和IFN-γ的变化差异均无统计学意义(P值均>0.05)。复苏后,血乳酸值在观察组降低、对照组轻度增高,组间比较差异均有统计学意义(P<0.05);但动脉血氧饱和度、中心静脉血氧饱和度、动脉氧分压、静脉氧分压改变组间比较差异均无统计学意义(P值均>0.05)。结论相比乳酸钠林格液,醋酸钠林格液复苏失血性休克患者,能更好地抑制外周血中的TNF-α及IL-6的表达,并能够降低血乳酸值,可以减轻体内炎症并纠正酸中毒,是有利于失血性休克患者的复苏液体。

Objective To investigate the effects of different fluids on resuscitation of peripheral blood inflammatory factors and arteriovenous blood gas in patients with traumatic hemorrhagic shock, and to provide a basis for screening relatively ideal resuscitation fluids. Methods A prospective controlled studie. Forty patients with hemorrhagic shock admitted to the emergency department of the First Affiliated Hospital of Bengbu Medical College between January 2016 and January 2019 were included in this study. Simple random grouping was used to divide all patients into observation group and control group, 20 cases in each group. The observation group was treated with acetated Ringer's solution and the control group was treated with lactated Ringer's solution. Restrictive fluid resuscitation was used in both groups. Peripheral vein, arterial, and central venous blood samples were taken before starting resuscitation, 30 minutes after resuscitation and 1 hour after resuscitation. Serum levels of interleukin(IL)-4, IL-6, interferon-γ(IFN-γ), tumor necrosis factor-α(TNF-α), arterial blood lactate, arterial oxygen saturation, central venous oxygen saturation, arterial partial pressure of oxygen, and venous partial pressure of oxygen were measured. The inflammatory factors of peripheral blood and arteriovenous blood gas were compared between the two groups to observe the resuscitation effect of the two fluids. Results There was no statistically significant difference in the general condition between the two groups (all P values>0.05). There were no statistically significant differences in the expression levels of inflammatory factors (IL-4, IL-6, IFN-γ, TNF-α) and arteriovenous blood gas between the two groups before the start of resuscitation (all P values>0.05). After 30 minutes and 1 hour of resuscitation, the expression levels of inflammatory factors in peripheral blood of the two groups of shock patient increased. There was no significant difference in the increase of IL-4 and IFN-γ between 30 minutes after resuscitation and 1 hour after resuscitation (all P values>0.05). The other indicators had statistical significance(all P values<0.05). An independent sample t-test was performed on the difference in the magnitude of the increase. Compared with lactated Ringer's solution, acetated Ringer's solution resuscitated hemorrhagic shock patients could reduce the release of inflammatory factors IL-6 and TNF-α and the difference was statistically significant(all P values<0.05). However, there was no significant difference in the changes of IL-4 and IFN-γ(all P values>0.05). The blood lactate value decreased in the observation group, while in the control group increased slightly, and the difference was statistically significant( P<0.05). However, there was no significant difference in arterial oxygen saturation, central venous oxygen saturation, arterial oxygen partial pressure, and venous oxygen partial pressure (all P values>0.05). Conclusions In resuscitates hemorrhagic shock patients, compared with lactated Ringer's solution, acetated Ringer's solution can better inhibit the expression of pro-inflammatory factors TNF-α and IL-6 in peripheral blood, and reduce blood lactate value, which can reduce the body inflammation and correction of acidosis. Acetated Ringer's solution is beneficial to fluid resuscitation in patients with hemorrhagic shock.