摘要
目的探讨超滤对严重失血性休克兔容量复苏后系统性炎症介质及内环境的影响。方法 10只日本大耳白兔随机分为超滤组和对照组。采用动脉放血和建立失血性休克模型,维持1 h后用生理盐水和自体血复苏。超滤组容量复苏结束30 min后以50~100 ml/min的血流量超滤4 h。分别于休克制模前(T0),容量复苏结束(T1),超滤结束(T2),超滤后2h(T3)、4 h(T4) 5个时间点抽取血标本测定白细胞介素6(interleukin 6,IL-6)、肿瘤坏死因子α(tumor necrosis factor alpha,TNF-α)、一氧化氮(nitric oxide,NO)、电解质和乳酸(lactate,Lac)、红细胞压积(hematocrit,Hct)等指标,并作动脉血气分析。结果与对照组比较,超滤后超滤组循环内IL-6、TNF-α和NO水平均显著降低(P<0.05或0.01);pH、HCO_3^-和BE值显著增高(P<0.05或0.01),PaCO_2显著下降(P<0.01);K^+浓度明显下降(P<0.01);血Lac水平降低(P<0.05或0.01)、Hct浓度升高(P<0.05或0.01)。结论超滤可以降低失血性休克/容量复苏(hemorrhagic shock/resuscitation,HS/R)后兔系统性炎症介质水平,改善水电酸碱等内环境,利于后期康复。
Objective To investigate the effects of ultrafiltration on inflammatory factor level and milieu interne after hemorrhagic shock and resuscitation.Methods Ten Japanese white rabbits were randomly divided into ultrafiltration group(n=5) and control group(n=5).In ultrafiltration group,the bloodletting was performed for hemorrhagic shock and maintained for 1 hour,then the resuscitation was done with autoblood and normal saline.Rabbits in ultrafiltration group were treated with ultrafiltration(blood flow:50~100 ml/min) for 4 hours at 30 minutes after fluid resuscitation.Blood samples were collected to measure plasma concentrations of interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),nitric oxide(NO),electrolyte,lactic acid(Lac) and hematocrit(Hct) at the times of before bleeding(T0),the end of resuscitation(T1) and ultrafiltration(T2),2 hours(T3) and 4 hours(T4) after ultrafiltration.And arterial blood gas analyses were detected at each point.Results Compared with control group,the plasma IL-6,TNF-α and NO levels,the concentrations of K+,the levels of PaCO2 and blood Lac were significantly descended in ultrafiltration group(P<0.05 or 0.01).And levels of pH,HCO3-,BE and Hct were obviously higher in ultrafiltration group(P<0.05 or 0.01).Conclusion Ultrafiltration could be helpful to reduce systemic inflammatory mediator and improve balance of milieu interne.
作者
黎笔熙
张燕辉
张艳
凌娜佳
王祥
程旺生
陶军
宋晓阳
LI Bixi;ZHANG Yanhui;ZHANG Yan;LING Najia;WANG Xiang;CHENG Wangsheng;TAO Jun;SONG Xiaoyang(Department of Anesthesiology,the General Hospital of Central Theatre Command,Wuhan Hubei 430070,China)
出处
《华南国防医学杂志》
CAS
2019年第2期82-85,91,共5页
Military Medical Journal of South China
基金
湖北省自然科学基金课题(JX5B40)
关键词
超滤
失血性休克
容量复苏
炎症因子
内环境
Ultrafiltration
Hemorrhagic shock
Resuscitation
Inflammatory factor
Milieu interne