不同液体复苏对创伤伴失血性休克兔肺损伤的影响及机制

Effect and mechanism of different fluids resuscitation on lung injury induced by trauma accompanied with hemorrhagic shock in rabbits

目的探讨醋酸林格液和成分比输血对创伤伴失血性休克兔肺损伤的影响及可能机制。方法 30只健康雄性新西兰大白兔随机分为对照组(C组)、醋酸林格组(AR组)、成分比输血组(CR组)。创伤伴失血性休克模型制作成功且维持1 h后,进行醋酸林格液及成分血血浆与浓缩红细胞(PRBC)1∶1复苏,维持收缩压90 mmHg(平均动脉压50 mmHg)左右,脉压≥30 mmHg,尿量≥0.5 ml/(kg·h)。复苏6 h后,测定肺泡灌洗液中性粒细胞计数,肺组织湿干重比值(W/D),肺组织病理学改变及水通道蛋白1(AQP1)及水通道蛋白5(AQP5)的表达水平。结果与C组比较,AR和CR组肺泡灌洗液中性粒细胞计数、肺组织W/D、肺组织病理学改变程度均降低(P<0.05);与AR组比较,CR组上述各指标均降低(P<0.05)。与C组比较,AR组AQP1表达上调(P<0.05),CR组AQP1、AQP5表达均上调(P<0.05);与AR组比较,CR组AQP1、AQP5表达上调(P<0.05)。结论醋酸林格液和成分比血液复苏均可在一定程度上减轻创伤伴失血性休克兔肺损伤,其机制可能与其增加组织灌注、改善肺水清除能力、上调肺组织AQP1和AQP5的表达相关。

Objective To explore the protective effect and possible mechanism of acetate Ringer′s and component blood transfusion on lung injury induced by trauma accompanied with hemorrhagic shock in rabbits.Methods Totally 30 male New Zealand white rabbits were randomly divided into 3 groups: control group(group C),acetate Ringer′s group(group AR),component blood transfusion group(group CR).One hour after models were established successfully, the animals in group AR and group CR would be resuscitated with acetated Ringer′s solution or component blood by plasma and PRBC at 1∶1.The artery systolic blood pressure was maintained at about 90 mmHg(mean arterial pressure was 50 mmHg),pulse pressure larger than 30 mmHg, and urine volume more than 0.5 ml/(kg·h).At 6 h after resuscitation, the neutrophil count in bronchoalveolar lavage fluid, W/D weight ratio and histopathology were detected by HE staining, and the expression of AQP1 and AQP5 in lung tissues was detected by immunohistochemistry.Results Compared with group C,neutrophil count of bronchoalveolar lavage fluid, W/D and lung tissue damage of AR group and CR group were decreased(P<0.05).Compared with group AR,neutrophil count of bronchoalveolar lavage fluid, W/D and lung tissue damage of CR group were decreased(P<0.05).The expression of AQP1 in group AR and the expression of AQP1 and AQP5 in group CR were significantly up-regulated as compared with group C(P<0.05);The expression of AQP1 and AQP5 in group CR was up-regulated compared with group AR(P<0.05).Conclusion Resuscitation with acetate Ringer′s and component blood can reduce the damage of lung tissue and the increase in tissue perfusion, the improvement in the ability to clear lung fluid after lung injury induced by trauma accompanied with hemorrhagic shock in rabbits, which may be related to the up-regulation of the expression of AQP1 and/or AQP5.