羟乙基淀粉13004急性高容量血液稀释对脓毒症兔肠黏膜屏障的影响.docVIP

羟乙基淀粉130/0.4急性高容量血液稀释对脓毒症兔肠黏膜屏障的影响 安徽省芜湖市，皖南医学院附属弋矶山医院麻醉科 241001 鲁卫华 金孝岠 鲁美静 电话 Email:lwh683@ 论文类别：危重医学临床与基础研究 【摘要】 目的 研究羟乙基淀粉（HES）30只h测量基础值后输注HES130/0.4 20ml/kg行高容量血液稀释,输入速率为20ml/min。三组术中补充生理需要量BES 10ml·kg-1·h-1。CASP模型后4h由右颈总动脉连接压力换能器，通过Medlab生物信号采集处理系统连续监测平均动脉压(MAP)、心率(HR)，监测呼吸频率及尿量，分离肠系膜上静脉。分别于造模后4h、8h开腹观察腹腔状况, 同时抽取颈动脉及肠系膜上静脉血液测定血气TNF-α、IL-10及D-乳酸水平。CASP后8小时处死动物，观察小肠黏膜病理学改变并行损伤评分。结果 (1)模型组CASP后4～8h MAP逐渐下降，HR逐渐增快，治疗组和对照组MAP、HR变化平稳。(2) 治疗组稀释后Hb下降约20%,达中度血液稀释。与对照组相比，CASP后4h模型组及治疗组肠氧摄氧率降低，血D-乳酸水平增高。但与4h比较，8h时模型组D-乳酸水平增高，治疗组D-乳酸水平降低，肠氧摄氧率增高。(3)CASP后4h，模型组及治疗组TNF-α高于对照组。CASP后8h，与对照组相比，模型组TNF-α及IL-10升高，而治疗组差异无统计学意义。(4)治疗组肠损伤病理学评分低于模型组。 结论 对脓毒症兔予HES130/0.4 行中度急性高容量血液稀释可保护肠屏障的结构功能。其机制可能与改善肠氧代谢，减少炎性介质的释放，维持抗炎和致炎因子的平衡有关。 【关键词】 羟乙基淀粉；血液稀释；脓毒症；肠黏膜；肿瘤坏死因子-α；白细胞介素-10 Effects of acute hypervolemic hemodilution with hydroxyethyl starch 130/0.4 on intestinal mucosal barrier in a rabbit model of sepsis LU Wei-hua, JIN Xiao-ju, Lu Mei-jing,et al. Department of Anesthesiology, Yijishan Hospital, Wannan Medical College, Wuhu 241001，China 【Abstract】 Objective To investigate the effects of acute hypervolemic hemodilution（AHH）with hydroxyethyl starch (HES) 130/0.4 on intestinal mucosal barrier in a rabbit model of sepsis and the possible mechanism. Methods Thirty healthy New Zealand rabbits were randomly divided into 3 groups(n=10 each): group Ⅰsham operation(C), group Ⅱsepsis model (E) and group Ⅲ AHH. Sepsis model was established according to modified colon ascendens stent peritonitis(CASP) in the study. Sham operation without puncturing the colonic wall were performed. At 4h after CASP model, AHH was then conducted with 6% HES 130/0.4 20ml·kg-1 infused iv at 50ml·min-1. Lactated Ringer,s solution was infused at 10ml·kg-1·h-1 in three groups during procedure. The animals breathed spontaneously during the experiment. A catheters was introduced into the right carotid artery for blood sampling and connected to a pressure transducer for continuous mean arterial p