摘要
目的 探讨不同液体复苏方案对未控制性重度失血性休克孕兔的肝、肾功能的影响。方法 20只孕兔制成未控制性重度失血性休克模型，随机分为假休克组（P组）、休克未处理组（P0组）、传统液体复苏组（PNL组）、限制性液体复苏组（PLH组），检测和比较急性失血、复苏期及观察期各组血清ALT、TNF-α、Cr的水平。结果实验期间P组ALT、TNF-α、Cr浓度未发生改变。实验30min，P0组、PLH组和PNL组ALT、TNF-α、Cr浓度均显著升高，三组间比较P均〉0．05。由于一直未给予处理，P0组ALT、TNF-α、Cr浓度持续升高，孕兔实验180min内因失血全部死亡。与P0组相比，早期液体输注可显著降低ALT、TNF-α、Cr水平。PLH组与PNL组比较，各时间点ALT显著降低（90min：83．2IU／L和124．8IU／L，180min：80．2IU／L和100．5IU／L，4h75．6IU／L和93．5IU／L，P均〈0．05，8h74．5IU／L和80．5IU／L，P〉0．05），TNF-α显著降低（90min：178．4pg／ml和242．3pg／ml，180min：195．2pg／ml和285．3pg／ml，4h205．6pg／ml和320．5pg／ml，8h：90．7pg／ml和210．8pg／ml，P均〈0．05），Cr显著降低（90min：145．2μmol／L和158．7μmol／L，P〉0．05，180min：150．9μmol／L和250．8μmol／L，4h：84．2μmol／L和198．5μmol／L，8h：75．4μmol／L和115．2μmol／L，P均〈0．05）。结论 限制性液体复苏能更好地改善未控制性重度失血性休克孕兔的肝、肾功能，更有效地保护组织脏器，为抢救产科重度失血性休克提供了实验依据和理论基础。
Objective To investigate the effects of different means of fluid resuscitation on hepatic and renal function of severe uncontrolled obstetric hemorrhagic shock. Methods The animal model of severe uncontrolled hemorrhagic shock was established in 20 pregnant rabbits. The rabbits were randomly assigned to pseudo shock group （P group）, untreated shock group （P0 group）, traditional fluid resuscitation group （PNL group）, and limited fluid resuscitation group （PLH group）. The levels of serum ALT, TNF-α and Cr were measured at hemorrhagic, resuscitating and observing stage. Results The concentrations of ALT, TNF-α and Cr in P group did not change during the experiment, but significantly increased at 30min within P0, PLH and PNL group although no statistical differences was found among them （P〉0. 05）. However, the levels of ALT, TNF-α and Cr in P0 group persistently increased and pregnant rabbits all died from bleeding within 180 min as no treatment was given in this group. The serum levels of serum ALT, TNF-α and Cr in the two fluid resuscitation groups were significantly lower than those in P0 group. Compared with PNL group, the concentration of ALT in PLH group significantly decreased at each time point （90 min. 83.2 IU/L vs 124.8 IU/L, 180 min. 80.2 IU/L vs 100.5 IU/L, 4 h. 75.6 IU/L vs 93.5 IU/L, P〈0.05,8 h： 74. 5 IU/L vs 80. 5 IU/L, P〉0.05） and the concentration of TNF-α was lower （90 min： 178.4 pg/ml vs 242.3 pg/ml, 180 rain： 195.2 pg/ml vs 285.3 pg/ml, 4 h： 205.6 pg/ml vs 320.5 pg/ml, 8 h： 90.7 pg/ ml vs 210. 8 pg/ml, P〈0. 05）, the concentration of Cr also decreased （90 min： 145. 2 μmol/L vs 158.7 μmol/L, P〉0.05, 180 min.. 150.9 μmol/L vs 250.8μmol/L, 4 h： 84.2 μmol/L vs 198.5 μmol/ L, 8 h： 75.4μmol/L vs 115.2μmol/L, P〈0.05）. Conclusions Limited fluid resuscitation can efficiently improve hepatic and renal function, protect tissues and organs, which may provide experimental evidence and theoretical base for severe uncontrolled obstetric hemorrhagic shock.
出处
《中华围产医学杂志》
CAS
2007年第4期256-259,共4页
Chinese Journal of Perinatal Medicine
基金
广东省重大社会问题联合攻关项目基金资助（编号：ZKB04701S）
关键词
复苏
休克
出血性
丙氨酸转氨酶
肿瘤坏死因子
肌酸酐
Resuscitation
Shock, hemorrhagic
Alanine transaminase
Tumor necrosis factor
Creatinine
