限制性液体复苏对非控制性失血性休克大鼠肠系膜淋巴循环的影响

doi:10.3760/cma.j.issn.1001-8050.2013.07.003

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摘要目的观察早期不同速度液体复苏对肠系膜淋巴循环的影响,了解限制性液体复苏的机制。方法健康雄性SD大鼠46只，失血+断尾法建立非控制性失血性休克（uncontrolled hemorrhagic shock， UHS）模型。将动物按随机数字表法分为假手术对照组（10只）、UHS模型组（12只）、快速复苏组（12只）和限制性复苏组（12只）。快速复苏组及限制性复苏组分别以5 ml·kg-1·min-1及1 ml·kg-1·min-1的速度输注乳酸林格液（LR），肠系膜主淋巴管插管收集淋巴液。记录淋巴液流量，检测血浆及淋巴液中蛋白浓度、内毒素及TNF-α的含量。结果复苏60 min时，快速复苏组和限制性复苏组淋巴液流量分别为（4.04 ±0.33） ml·kg-1·h-1和（1.79±0.18） ml·kg-1·h-1（P<0.01）；快速复苏组和限制性复苏组蛋白输出量分别为（80.5 ±10.2） mg·kg-1·h-1和（43.1±9.6） mg·kg-1·h-1（P<0.01）。复苏240 min时，快速复苏组和限制性复苏组淋巴液内毒素含量分别为（1.36±0.41）EU/ml和（0.81±0.26）EU/ml（P<0.01）。复苏120 min时，快速复苏组和限制性复苏组淋巴液中TNF-α含量分别为（3.86±0.23） ng/ml和（2.63±0.52） ng/ml（P<0.05）。结论 UHS导致肠系膜淋巴循环障碍，限制性液体复苏可以改善肠系膜淋巴循环。

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	杨鹤鸣
	崔彦
	杨建武
	李晓鸥
	付晓艳
	赵燕
	付自臣
	刘景欣
	胡刚
	黄镇

关键词 ：休克, 出血性, 复苏术, 肠系膜, 淋巴

Abstract：Objective To examine the effect of early fluid resuscitation at different speed on mesenteric lymph circulation and learn the mechanism of limited fluid resuscitation. Methods Forty-six SD rats were subjected to uncontrolled hemorrhagic shock (UHS) by bleeding and tail amputation. The animals were assigned to sham group (n=10), UHS group (n=12), aggressive resuscitation group (n=12) and limited resuscitation group (n=12), according to random number table. Aggressive resuscitation and limited resuscitation groups were infused with Lactated Ringer’s solution at the speed of 5 ml·kg-1·min-1 and 1 ml·kg-1·min-1 respectively. Catheterization of the main mesenteric lymphatic duct allowed the collection of lymph fluid. Flow of mesenteric lymph fluid was recorded and levels of protein, endotoxin and TNF-α in plasma as well as lymph fluid were determined. Results At 60 minutes, the aggressive and limited resuscitation groups showed the lymph flow of (4.04±0.33) ml·kg-1·h-1 and (1.79±0.18) ml·kg-1·h-1 (P<0.01) and protein output of (80.5±10.2) mg·kg-1·h-1 and (43.1±9.6) mg·kg-1·h-1 (P<0.01). At 240 minutes, the aggressive and limited resuscitation groups showed endotoxin level of (1.36±0.41) EU/ml and (0.81±0.26) EU/ml in lymph fluid (P<0.01). At 120 minutes, the aggressive and limited resuscitation groups showed TNFα level of (3.86±0.23) ng/ml and (2.63±0.52) ng/ml in lymph fluid (P<0.01). Conclusion UHS may lead to disorder of mesenteric lymph circulation, as may be improved by the limited fluid resuscitation.

Key words： Shock, hemorrhagic Resuscitation Mesentery Lymph

引用本文:

杨鹤鸣,崔彦,杨建武等. 限制性液体复苏对非控制性失血性休克大鼠肠系膜淋巴循环的影响[J]. 中华创伤杂志, 2013, 29(7): 584-587.

YANG He-ming,CUI Yan,YANG Jian-wu et al. Effect of limited fluid resuscitation on mesenteric lymph circulation in rats with uncontrolled hemorrhagic shock[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(7): 584-587.

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http://www.zhcszz.com/CN/10.3760/cma.j.issn.1001-8050.2013.07.003 或 http://www.zhcszz.com/CN/Y2013/V29/I7/584

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