丙酮酸钠液腹腔复苏对失血性休克大鼠肠黏膜屏障的保护作用.docVIP

丙酮酸钠液腹腔复苏对失血性休克大鼠肠黏膜屏障的保护作用 　　DOI：10.3760/cma.j.issn.1671-0282.2014.10.012 　　基金项目：国家自然科学基金30971626） 　　【摘要】目的 探讨丙酮酸钠液腹腔复苏对失血性休克大鼠肠黏膜屏障的保护作用。方法 健康清洁级雄性SD大鼠，40只随机（随机数字法）分为4组：假手术组（Ⅰ组）、失血性休克模型组（Ⅱ组），复方氯化钠静脉复苏+PD-2液腹腔复苏组（Ⅲ组），复方氯化钠静脉复苏+丙酮酸钠腹腔复苏组（Ⅳ组），每组10只。采用Wiggers改良法制备失血性休克模型。Ⅱ组行右颈总动脉、右股静脉、左股动脉插管及全身肝素化。Ⅲ组、Ⅳ组行静脉复苏的同时，分别向腹腔内注入2.5% PD-2液20 mL和2.5%丙酮酸钠液20 mL。2 h后取动脉血测血气（pH、PaCO2、PaO2）和D-乳酸含量，光镜下观察各组大鼠小肠黏膜组织形态变化。结果 血气分析：Ⅲ组、Ⅳ组较Ⅱ组pH水平及PaO2含量明显升高（P 0.01）；与Ⅲ组比较，Ⅳ组pH水平及PO2水平升高更为明显（P 0.05）。D-LA含量：Ⅲ组、Ⅳ组较Ⅱ组明显降低（P 0.01）；与Ⅲ组比较，Ⅳ组D-LA降低更明显（P 0.05）。光镜下Ⅱ组大鼠小肠黏膜层绒毛高度水肿，黏膜下血管塌陷，大片黏膜绒毛坏死、脱落，缺损；Ⅲ组和Ⅳ组小肠黏膜破坏较Ⅱ组明显减轻；Ⅳ组大鼠小肠黏膜绒毛水肿、倒伏及坏死程度均轻于Ⅲ组。小肠上皮损伤指数评分：Ⅳ组高于Ⅱ组及Ⅲ组（P 0.01 or P 0.05）。结论 静脉复苏加腹腔复苏可降低失血性休克大鼠血浆D-LA含量、纠正酸中毒，提高氧分压；并且对于肠黏膜屏障的保护作用，丙酮酸钠液作用优于PD-2液。 　　【关键词】失血性休克；肠黏膜；腹腔复苏；丙酮酸钠；D-乳酸 　　The protective effect of sodium pyruvate solution to intestinal barrier in hemorrhagic shock rats by intraperitoneal resuscitation 　　Wang Xiaozhou，Lu Xiaoguang，Kang Xin，Fan Zhiwei，Guo Shuai，Liang Zhengkai.Emergency Medicine Department，Affiliated Zhongshan Hosipital of Dalian University，Dalian 116001，China 　　【Abstract】Objective To study the protective effect of sodium pyruvate solution to intestinal barrier in Hemorrhagic shock rats by intraperitoneal resuscitation.Methods A total of 40 Male SD ratswere healthy and clean， were randomly（random number） divided into four groups： sham operation group （groupⅠ）， hemorrhagic shock model group （group Ⅱ）， the recovery of the compound sodium chloride intravenous + intraperitoneal recovery of the PD-2 liquid group （groupⅢ）， the recovery of the compound sodium chloride intravenous + sodium pyruvate abdominal recovery group （groupⅣ ） （n =10）. In addition to the group Ⅰ， the other three groups are used the HS model by The Wiggers improvement prepared.group Ⅲ， Ⅳ were used the same amount of intravenous recovery， At the same time to the abdominal cavity were respectively injected 20 mL 2.5% PD-2 liquid and 20 m 2.5%sodium pyruvate solution .After 2 h， each group