Effects of Different Fluids on Microcirculation and Inflammatory Factors in Rabbits with Hemorrhagic Shock
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摘要:
目的 研究不同类型液体复苏对失血性休克兔肠系膜微循环及炎性因子的影响。 方法 从兔颈总动脉处放血使平均动脉压较基础值下降40%，建立失血性休克模型。随机分成实验对照组、生理盐水组、乳酸林格组、醋酸林格组、羟乙基淀粉组以及琥珀酰明胶组，每组8只。肠系膜微循环用微循环观测仪监测。记录放血前（T0）、失血性休克时（T1）、液体复苏开始时（T2）、液体复苏完成时（T3）、实验结束时（T4）各组的平均动脉压（MAP）、心率（HR）、微循环灌注血管比例（PPV）和微血管血流指数（MFI）；测定T0、T2、T4时刻肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1）和乳酸（Lac）含量。 结果 乳酸林格组与羟乙基淀粉组的T3时刻MAP比较，差异有统计学意义（P < 0.05），除外琥珀酰明胶组，羟乙基淀粉组在T4时刻的MAP高于其他组别，差异有统计学意义（P < 0.05），T4时刻实验对照组与各组差异有统计学意义（P < 0.05）；除外琥珀酰明胶组，T4 时刻羟乙基淀粉组和琥珀酰明胶组的PPV及MFI均高于生理盐水组、乳酸林格组、醋酸林格组（P < 0.05），T4 时刻羟乙基淀粉组乳酸值最低，与乳酸林格组、生理盐水组比较，差异有统计学意义（P < 0.05），T4时刻，各组与实验对照组差异有统计学意义（P < 0.05）；各组TNF-α及IL-1在T0、T2 、T4时刻比较，差异均无统计学意义（P > 0.05）。 结论 羟乙基淀粉液和琥珀酰明胶液可以改善失血性休克兔的微循环，但不能改善失血性休克兔的炎性因子水平。 Abstract:Objective To study the effects of different types of fluid resuscitation on mesenteric microcirculation and inflammatory factors in rabbits with hemorrhagic shock. Methods The model of hemorrhagic shock rabbits was established by reducing the basic mean arterial pressure by 40% through draining the blood from the common carotid artery. Animals were randomly divided into control group, saline group, lactate Ringer group, acetic acid Ringer group, hydroxyethyl starch group and succinyl gelatin group with 8 animals in each group. Mesenteric microcirculation was monitored with microcirculation monitor. Mean arterial pressure（MAP）, heart rate（HR）, microvascular perfusion ratio（PPV） and microvascular blood flow index（MFI） were recorded before bleeding（T0）, at hemorrhagic shock（T1）, at the beginning of fluid resuscitation（T2）, at the completion of fluid resuscitation（T3）, and at the end of the experiment（T4）. The contents of tumor necrosis factor-α（TNF-α）, interleukin-1（IL-1） and lactic acid（Lac） were measured at T0, T2 and T4. Results Compared with hydroxyethyl starch group, there were statistically significant differences in T3 MAP（P < 0.05）, except for succinyl gelatin group, hydroxyethyl starch group had higher MAP at T4 than other groups, the difference was statistically significant（P < 0.05）. The differences in MAP between experimental control group and other groups were statistically significant at T4 （P < 0.05）. PPV and MFI of hydroxyethyl starch group and succinyl gelatin group were higher than those of normal saline group, lactic acid Ringer group and acetic acid Ringer group at T4（P < 0.05）, and the lactic acid value of hydroxyethyl starch group at T4 was the lowest, compared with lactic acid Ringer group and normal saline group, the difference was statistically significant（P < 0.05）. There were statistical significances between all groups and experimental control group at T4 （P < 0.05）. There were no significant differences in TNF-αand IL-1 in T0, T2 and T4 among all groups（P < 0.05）. Conclusion Hydroxyethyl starch solution and succinyl gelatin solution can improve the microcirculation of rabbits with hemorrhagic shock, but can not improve the level of inflammatory factors. -
Key words:
- Hemorrhagic shock /
- Rabbit /
- Fluid resuscitation /
- Microcirculation /
- Inflammatory factor
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表 1 体重、尿量、放血量体量比较（$ \bar x \pm s $）
Table 1. Comparison of weight，urine output，and blood letting volume（$ \bar x \pm s $）
组别 只数（n） 体重（kg） 尿量（mL） 放血量（mL） 实验对照组 8 2.79±0.29 4.67 ±2.58 34.17± 7.33 生理盐水组 8 2.49±0.31 21.00±4.82* 29.83± 7.25 乳酸林格组 8 2.51±0.34 20.50± 4.23* 28.17±11.84 醋酸林格组 8 2.73±0.27 23.83±7.55* 40.00± 7.48 羟乙基淀粉组 8 2.65±0.23 17.17±2.79* 42.33± 9.25 琥珀酰明胶组 8 2.58±0.27 15.33±1.45* 35.67± 7.31 F − 1.388 13.220 2.500 P − 0.257 < 0.001# 0.052 #P < 0.05。与对照组比较，*P < 0.05。 
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表 2 不同液体复苏对HR的影响（$ \bar x \pm s $，n = 8）
Table 2. Effects of different types of fluid resuscitation on HR（$ \bar x \pm s $，n = 8）
组别 HR（次/min） T0 T1 T2 T3 T4 实验对照组 239.17 ± 13.66 244.17 ± 10.67 241.67 ± 6.98 − 226.67 ± 13.78 生理盐水组 232.33 ± 14.57 242.50 ± 7.99 239.67 ± 7.69 238.67 ± 10.77 239.33 ± 14.79 乳酸林格组 233.83 ± 16.67 240.33 ± 9.99 236.67 ± 7.69 239.83 ± 18.25 239.17 ± 13.98 醋酸林格组 238.17 ± 7.49 245.33 ± 9.93 244.83 ± 6.82 242.67 ± 10.93 242.17 ± 10.05 羟乙基淀粉组 235.67 ± 13.47 242.67 ± 11.69 231.83 ± 7.68 229.33 ± 15.95 230.17 ± 22.74 琥珀酰明胶组 234.17 ± 11.36 248.17 ± 5.67 236.67 ± 6.98 242.83 ± 6.59 243.00 ± 8.37 F 0.243 0.482 2.305 1.056 1.259 P 0.940 0.786 0.069 0.399 0.307
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表 3 不同液体复苏对MAP的影响（$ \bar x \pm s $，n = 8）
Table 3. Effects of different types of fluid resuscitation on MAP（$ \bar x \pm s $，n = 8）
组别 MAP（mmHg） T0 T1 T2 T3 T4 实验对照组 88.50 ± 9.14 52.50 ± 5.24a 51.50 ± 5.09 − 41.67 ± 8.94 生理盐水组 93.17 ± 5.27 55.00 ± 2.61 a 55.33 ± 3.45 77.67 ± 8.82b 68.67 ± 16.10*▲c 乳酸林格组 92.50 ± 12.34 50.83 ± 8.50 a 54.33 ± 10.63 65.33 ± 15.82 ▲b 64.83 ± 9.54*▲ 醋酸林格组 85.00 ± 11.08 47.83 ± 7.41 a 54.33 ± 7.74 77.17 ± 5.38 b 69.67 ± 6.35* 羟乙基淀粉组 82.83 ± 13.73 45.00 ± 2.53 a 51.50 ± 4.89 86.00 ± 6.81 b 88.00 ± 8.46* 琥珀酰明胶组 83.90 ± 11.80 41.67 ± 3.20 a 49.50 ± 5.54 77.33 ± 11.38 b 78.00 ± 10.70* F 0.998 3.194 0.689 3.057 13.226 P 0.436 0.020# 0.636 0.035# < 0.001# #P < 0.05。与实验对照组比较，*P < 0.05；与羟乙基淀粉组比较，▲P < 0.05；与T0比较，aP < 0.05；与T2比较，bP < 0.05；与T3比较，cP < 0.05。
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表 4 不同液体复苏对PPV的影响（$ \bar x \pm s $，n = 8）
Table 4. Effects of different types of fluid resuscitation on PPV（$ \bar x \pm s $，n = 8）
组别 PPV（%） T0 T1 T2 T3 T4 实验对照组 93.63 ± 5.54 55.37 ± 9.16 a 55.93 ± 7.58 − 56.08 ± 8.15▲△ 生理盐水组 95.50 ± 4.56 54.62 ± 8.26 a 50.95 ± 10.88 87.38 ± 6.68b 84.76 ± 2.31*▲△ 乳酸林格组 95.21 ± 3.88 62.77 ± 7.22 a 58.46 ± 7.70 91.16 ± 5.43 b 84.79 ± 5.01*▲△ 醋酸林格组 96.54 ± 4.01 57.63 ± 9.10 a 53.52 ± 10.89 90.39 ± 5.63 b 85.90 ± 5.97*▲△ 羟乙基淀粉组 93.03 ± 5.62 59.27 ± 6.96 a 61.14 ± 5.95 94.35 ± 4.80 b 95.90 ± 3.52*△ 琥珀酰明胶组 95.31 ± 3.81 60.49 ± 8.03 a 59.92 ± 9.97 90.80 ± 7.64 b 95.80 ± 4.71*▲ F 0.475 0.909 1.193 1.053 47.096 P 0.792 0.488 0.335 0.399 < 0.001# #P < 0.05。与实验对照组比较，*P < 0.05；与羟乙基淀粉组比较，▲P < 0.05；与琥珀酰明胶组比较，△P < 0.05；与T0比较，aP<0.05；与T2比较，bP < 0.05。
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表 5 不同液体复苏对MFI的影响（$ \bar x \pm s $，n = 8）
Table 5. Effects of different types of fluid resuscitation on MFI（$ \bar x \pm s $，n = 8）
组别 MFI（分值） T0 T1 T2 T3 T4 实验对照组 2.87 ± 0.14 1.85 ± 0.24a 1.80 ± 0.19 − 1.88 ± 0.15 生理盐水组 2.91 ± 0.10 1.86 ± 0.17 a 1.76 ± 0.30 2.68 ± 0.20b 2.57 ± 0.25*▲△ 乳酸林格组 2.90 ± 0.09 2.03 ± 0.12 a 1.94 ± 0.23 2.79 ± 0.14 b 2.55 ± 0.17*▲△ 醋酸林格组 2.91 ± 0.09 1.94 ± 0.25 a 1.76 ± 0.36 2.74 ± 0.20 b 2.72 ± 0.27* 羟乙基淀粉组 2.92 ± 0.09 2.03 ± 0.08 a 1.96 ± 0.23 2.92 ± 0.10 b 2.94 ± 0.10* 琥珀酰明胶组 2.93 ± 0.06 1.99 ± 0.23 a 1.98 ± 0.28 2.82 ± 0.12 b 2.92 ± 0.10* F 0.252 1.101 0.896 1.982 25.786 P 0.935 0.380 0.496 0.127 < 0.001# #P < 0.05。与实验对照组比较，*P < 0.05; 与羟乙基淀粉组比较，▲P < 0.05；与琥珀酰明胶组比较，△P < 0.05；与T0比较，aP < 0.05；与T2比较，bP < 0.05。
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表 6 不同液体复苏对TNF-α的影响（$ \bar x \pm s $，n = 8）
Table 6. Effects of different types of fluid resuscitation on TNF-α （$ \bar x \pm s $，n = 8）
组别 TNF-α（pg/mL） T0 T2 T4 实验对照组 530.90±43.30 586.75±45.07 a 625.13±40.04 生理盐水组 498.84±19.48 578.00±21.57 a 597.27±34.35 乳酸林格组 497.63±26.21 595.43±40.84 a 599.15±22.37 醋酸林格组 505.95±15.86 556.81±45.19 a 572.52±42.40 羟乙基淀粉组 500.58±35.79 554.26±41.79 a 594.58±46.09 琥珀酰明胶组 501.79±55.45 592.59±53.72 a 620.65±38.81 F 0.761 1.065 1.518 P 0.585 0.399 0.214 与T0比较，aP < 0.05。
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表 7 不同液体复苏对IL-1的影响（$ \bar x \pm s $，n = 8）
Table 7. Effects of different types of fluid resuscitation on IL-1（$ \bar x \pm s $，n = 8）
组别 IL-1（ng/L） T0 T2 T4 实验对照组 102.17±8.99 109.49±16.88 114.33±13.60 生理盐水组 92.13±14.30 108.25±11.45 116.70±16.70 乳酸林格组 85.19±15.26 100.51±17.73 107.48±11.36 醋酸林格组 87.16±11.25 95.70±12.14 98.17±11.07 羟乙基淀粉组 84.13±7.26 98.22±11.64 110.01±11.04 琥珀酰明胶组 85.65±14.86 102.65±11.11 109.66±12.01 F 1.843 0.953 1.523 P 0.135 0.462 0.212
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表 8 不同液体复苏对Lac的影响（$ \bar x \pm s $，n = 8）
Table 8. Effects of different types of fluid resuscitation on Lac（$ \bar x \pm s $，n = 8）
组别 Lac（mmol/L） T0 T2 T4 实验对照组 1.98±0.44 6.91±0.92a 10.63±1.06b 生理盐水组 2.33±0.48 7.65±0.69 a 5.67±0.94*▲b 乳酸林格组 2.19±0.28 8.61±1.33 a 6.43±1.99*▲b 醋酸林格组 2.02±0.59 7.07±0.82 a 4.74±1.19* b 羟乙基淀粉组 2.37±0.29 8.00±1.15 a 3.22±1.02* b 琥珀酰明胶组 1.99±0.28 8.32±1.40 a 4.34±1.50* b F 1.086 2.356 22.842 P 0.388 0.064 < 0.001# #P < 0.05。与实验对照组比较，*P < 0.05；与羟乙基淀粉组比较，▲P < 0.05；与T0比较，aP < 0.05；与T2比较，bP < 0.05。
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