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目的:观察腹腔复苏(DPR)对失血性休克大鼠血流动力学参数、动脉血乳酸值以及小肠组织髓过氧化物酶(MPO)活性、丙二醛(MDA)含量、NO含量、湿干重比和肿瘤坏死因子-α(TNF-α)表达的影响,探讨腹腔复苏对失血性休克大鼠的保护作用及其可能的机制。方法:采用大鼠股动脉抽血法制备失血性休克动物模型。健康雄性SD大鼠50只,随机分为5组,每组10只。即假手术组(Sham组)、常规静脉复苏组(CR组)、腹腔复苏生理盐水组(DPR1组)、腹腔复苏羟乙基淀粉组(DPR2组)、腹腔复苏腹膜透析液组(DPR3组)。各DPR组在常规静脉复苏的同时行腹腔复苏。复苏后2h股动脉采血测定乳酸值,同时检测小肠组织MPO活性、MDA含量、NO含量和湿干重比,采用免疫组化法检测小肠组织TNF-α表达水平,光镜下观察小肠黏膜组织的病理变化,评估小肠黏膜上皮损伤指数。结果:与Sham组比较,CR组、DPR1组、DPR2组、DPR3组动脉血乳酸含量明显升高(P<0.01);与CR组比较,各腹腔复苏组的乳酸含量降低,但DPR3组显著降低,差异有统计学意义(P<0.05)。与Sham组比较,各休克复苏组小肠组织的MPO活性、MDA含量、湿干重比、TNF-α表达和黏膜损伤指数均显著增加(P<0.05或P<0.01);与CR组比较,各腹腔复苏组的相应指标均有所下降,但DPR3组下降显著,差异有统计学意义(P<0.05或P<0.01)。与Sham组比较,各休克复苏组NO含量均明显降低(P<0.01);与CR组比较,DPR3组NO含量有一定程度的回升,差异有统计学意义(P<0.01)。光镜下休克复苏后各组小肠黏膜上皮均有不同程度的损伤,但DRP3组这种损伤有所减轻(P<0.01)。结论:腹膜透析液行腹腔复苏对失血性休克大鼠具有保护作用。其机制可能与其抑制炎性反应、减轻组织脂质过氧化反应以及减轻组织水肿有关。
OBJECTIVE: To observe the effects of peritoneal resuscitation (DPR) on hemodynamics, arterial blood lactic acid and MPO activity, malondialdehyde (MDA) content, NO content, Heavy ratio and the expression of tumor necrosis factor-α (TNF-α), and to explore the protective effect and possible mechanism of celiac resuscitation in hemorrhagic shock rats. Methods: Hemorrhagic shock animal models were prepared by rat femoral artery blood drawing. Fifty healthy male Sprague Dawley rats were randomly divided into 5 groups with 10 in each group. (Sham group), conventional venous resuscitation group (CR group), peritoneal resuscitation saline group (DPR1 group), peritoneal resuscitation hydroxyethyl starch group (DPR2 group), peritoneal resuscitation peritoneal dialysis fluid group (DPR3 group) . Each DPR group underwent routine abdominal resuscitation with abdominal resuscitation. Blood samples were taken from the femoral artery 2 h after resuscitation to determine the concentration of lactate, and the activity of MPO, the content of MDA, the content of NO and the ratio of dry weight to weight of the intestine were measured. The expression of TNF-α in small intestine tissue was detected by immunohistochemical method. Pathological changes, assessment of intestinal mucosal epithelial injury index. Results: Compared with Sham group, the content of lactic acid in CR group, DPR1 group, DPR2 group and DPR3 group was significantly increased (P <0.01). Compared with CR group, the content of lactic acid in each group was decreased , The difference was statistically significant (P <0.05). Compared with Sham group, the MPO activity, MDA content, wet-dry weight ratio, TNF-αexpression and mucosal injury index in intestinal tissue of shock resuscitation group were significantly increased (P <0.05 or P <0.01) The corresponding indexes of celiac resuscitation group decreased, but the DPR3 group decreased significantly, the difference was statistically significant (P <0.05 or P <0.01). Compared with Sham group, the content of NO in all resuscitation groups was significantly decreased (P <0.01). Compared with CR group, NO content in DPR3 group increased to a certain degree (P <0.01). After shock resuscitation, all groups of intestinal mucosal epithelium had different degree of damage, but the damage of DRP3 group was alleviated (P <0.01). CONCLUSION: Peritoneal dialysate has a protective effect on hemorrhagic shock rats after celiac resuscitation. The mechanism may be related to its inhibition of inflammatory reactions, reduce tissue lipid peroxidation and reduce tissue edema.