低血压(失血休克)一小时扩容救治后免疫功能变化及其探讨

The Changes and Mechanisms of Immune Function after Hypotention One Hour following Resuscitation

用严格无菌术将大鼠循环血分流至储血器使动脉血压(ABP)平衡在5.33kPa 1h,再将全部血回输并加生理盐水扩容救治,第三日采血作免疫检查,结果:(1)非特异免疫:白细胞总数及分类计数只见单核细胞数增多,用碳粒廓清法检出巨噬细胞吞噬指数明显降低,有单核巨噬细胞功能抑制,用~3H—TdR掺入法测得全血白细胞(主要为小吞噬细胞)吞噬指数与对照组无统计差异,再用同一正常大鼠全血分别加对照血浆和休克血浆亦无统计意义,小吞噬细胞功能未受影响,休克血浆中无影响其功能的因子。(2)细胞免疫:用放免法测得T淋巴细胞对PHA反应显著降低。将休克全血加内毒素共育后,T淋巴细胞转化值与不加内毒素接近全同,均低于对照值。用同一正常大鼠全血加休克前血浆与加休克血浆相比,只有休克血浆可抑制正常T淋巴细胞转化,说明休克血浆中有抑制T淋巴细胞转化的因子存在但不是内毒素。(3)体液免疫:用溶血素形成试验测得休克组HC_(50)与对照无差异。

In this study we attempted to detect the immuno-changes and their mechanisms after simple hypotention one hour following resuscitation on the third day. Under sterile condition, the circulating blood was transited from the femoral artery into a reservior to maintain ABP at 5.88kPa level for one hour. Then the shed blood and normal saline 1.5ml/100 g·bw were reinfused. On the third day, the blood samples were withdrawn from the heart to assay the immunofunction alterations. Conetution: (1) Simple hypotention one hour could inhibite the lymphocytic proliferation response to PHA and this depression was unrelated to endotoxin. (2) The function of rediculoendothelial system was still depressed on the third day after hypotention one hour. There may be a plasma depression factor presenting in shock plasma. (3) Our results indicated that the hypotention one hour had no effect on the phagocytic function of peripheral blood cells and no plasma inhibitor which depressed this reaction in shock group was found.