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目的研究不同剂量液体复苏对失血性休克大鼠肠损伤及肠黏膜通透性的影响。方法将72只SD大鼠随机分成4组(n=18):高剂量液体复苏组(HLR组)、中剂量液体复苏组(MLR组)、低剂量液体复苏组(LLR组)及未复苏组(Sham组),前3组的液体复苏剂量分别为45、30和15 mL/(kg·h)。复苏后检测所有大鼠肠黏膜的通透性。于复苏后24、48及72 h,均分别抽取6只大鼠检测动脉血中乳酸和静脉血中肿瘤坏死因子-α(TNF-α)的水平,测量肠湿/干重比,进行小肠组织病理学检查并评分。结果复苏后,HLR组的肠黏膜通透性高于其余3组(P<0.05)。复苏3~8 h内,Sham组的所有大鼠均死亡,而其余3组大鼠均存活。术后24 h时LLR组的乳酸水平低于其余2组(P<0.05);HLR组的TNF-α水平在术后24、48及72 h均高于其余2组(P<0.05),在48 h时,LLR组低于MLR组(P<0.05);术后24 h时,LLR组的肠湿/干重比最低,HLR组最高(P<0.05)。HE染色结果显示,3组大鼠肠黏膜损伤严重程度均随时间好转,但在48和72 h时,LLR组的肠绒毛基本正常。结论复苏剂量为15 mL/(kg·h)的限制性液体复苏能降低失血性休克大鼠术后早期酸中毒的程度和TNF-α的释放,降低肠黏膜通透性,减轻对肠道的损伤。
Objective To study the effects of different doses of liquid resuscitation on intestinal injury and intestinal mucosal permeability in hemorrhagic shock rats. Methods 72 SD rats were randomly divided into 4 groups (n = 18): high dose liquid resuscitation group (HLR group), middle dose liquid resuscitation group (MLR group), low dose liquid resuscitation group (LLR group) and non-resuscitation group (Sham group), the first three groups of liquid resuscitation dose were 45,30 and 15 mL / (kg · h). Permeability of intestinal mucosa in all rats after resuscitation. At 24, 48 and 72 h after resuscitation, 6 rats were respectively taken for the determination of the levels of tumor necrosis factor-α (TNF-α) in lactic acid and venous blood of arteries, the intestine wet / dry weight ratio was measured, Pathological examination and score. Results After resuscitation, the permeability of intestinal mucosa in HLR group was higher than the other three groups (P <0.05). Within 3 to 8 h of resuscitation, all rats in Sham group died, while the other 3 rats survived. The level of lactate in LLR group was significantly lower than that in the other two groups at 24 h after operation (P <0.05). The levels of TNF-α in HLR group were higher than those in other two groups at 24 h, 48 h and 72 h after operation (P <0.05) At 48 h, the LLR group was lower than the MLR group (P <0.05). The intestinal wet / dry weight ratio was the lowest in the LLR group and the highest in the HLR group at 24 h after operation (P <0.05). HE staining showed that the severity of intestinal mucosal injury improved over time in all three groups, but at 48 and 72 h, the intestinal villi in LLR group were almost normal. Conclusion Resuscitative fluid resuscitation with a dose of 15 mL / (kg · h) can reduce the degree of early postoperative acidosis and the release of TNF-α in rats after hemorrhagic shock, decrease the permeability of intestinal mucosa, damage.