失血性休克大鼠肠缺血再灌注损伤后静脉复苏同时丙酮酸钠腹腔复苏的临床观察

Effect observation of venous resuscitation and intraperitoneal resuscitation with sodium pyruvate on hemorrhagic shock rats after intestinal ischemia-reperfusion injury

目的观察失血性休克大鼠肠缺血再灌注损伤后静脉复苏同时丙酮酸钠溶液腹腔复苏的临床效果。方法40只大鼠随机分成4组,除Sham组外,其他3组均进行失血性休克造模及液体复苏,VR组只进行静脉复苏,Lac组、PY组静脉复苏同时进行腹腔复苏,腹腔复苏液体分别为2.5%葡萄糖乳酸钠腹透液,1.1%的丙酮酸钠溶液。连续监测大鼠平均动脉压(MAP)。复苏后180 min,检测小肠组织内髓过氧化物酶(MPO)、丙二醛(MDA)、诱导型一氧化氮合酶(iNOS)、TNF-α、IL-6,同时取各组小肠组织做HE染色,观察光镜下小肠黏膜形态学及电镜下小肠黏膜亚细胞结构。结果复苏后10~180 min,VR组MAP均低于Lac组及PY组(P均<0.05)。复苏后60~180 min,Sham组MAP高于PY组(P均<0.05),PY组与Lac组MAP比较,P均﹥0.05。复苏后180 min,各组MDA、MPO、TNF-α比较:Sham组<PY组<Lac组<VR组,P均<0.05;iNOS、IL-6比较:Sham组、PY组<Lac组<VR组,P均<0.05。PY组小肠组织在光镜下病理变化和电镜的亚细胞结构改变上较其他组均明显减小。结论与单纯静脉复苏及静脉复苏同时葡萄糖乳酸钠腹腔复苏比较,失血性休克大鼠肠缺血再灌注损伤后静脉复苏同时丙酮酸钠溶液腹腔复苏能维持血流动力学稳定,有效地抑制小肠氧化应激、炎症反应,保护损伤的肠黏膜。

Objective To observe the effects of the combined treatment of intraperitoneal resuscitation(PR)with sodium pyruvate(PY)and venous resuscitation(VR)on hemorrhagic shock(HS)rats after intestinal ischemiareperfusion injury.Methods Forty rats were randomly divided into four groups.With the exception of group Sham,the models of HS were established in the other three groups and then received fluid and resuscitation.Rats in the group VR only received VR while the group Lac and group PY received PR with PY,and the PR fluid was 2.5%glucose lactate peritoneal dialysis(Lac)fluid and 1.1%PY solution,respectively.Mean arterial pressure(MAP)was monitored continuously.After 180 min resuscitation,intestinal myeloperoxidase(MPO),malondialdehyde(MDA),inducible nitric oxide synthase(iNOS),tumor necrosis factorα(TNFα),and interleukin6(IL6)were measured.In addition,we took small intestine tissue from each group for HE staining,and the morphological and the subcellular structure changes of the small intestinal mucosa were observed by light microscopy and electron microscopy,respectively.Results After 10180 min resuscitation,MAP of group VR was lower than that of group Lac and group PY(P<0.05).After 60180 min resuscitation,the MAP of group Sham was higher than that of group PY(P<0.05),and there was no significant difference between group PY and group Lac(P>0.05).After 180 min resuscitation,the comparisons of MDA,MPO,and TNFαshowed:group Sham<group PY<group Lac<group VR(all P<0.05);the comparisons of iNOS and IL6 showed:group Sham,group PY<group Lac<group VR(all P<0.05).Group PY had less pathological and subcellular changes than the other experimental groups.Conclusion Compared with VR only,the combined treatment of VR and PR with PY shows more superiorities of maintaining hemodynamic stability,inhibiting oxidative stress and inflammatory responses,and protecting the injured intestinal mucosa of HS rats after intestinal ischemiareperfusion injury.