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目的探讨应用羟乙基淀粉(HES)溶液中添加多聚人胎盘血红蛋白(Poly Hb)对重度失血性休克大鼠模型肠缺血再灌注的影响。方法将32只SD大鼠失血至全身血容量(大鼠体重的6.5%)的60%,分别将大鼠股动静脉插管后,从股动脉端开始放血直至放血量达到大鼠全身血容量的60%,然后随机均分为4组(8只/组),包括3个人工胶体液组,即HES组:6%HES130/0.4氯化钠注射液;红细胞+HES(RBC+HES)组:将大鼠自身血液反复离心洗涤3次,留取红细胞,加入到HES溶液中,使Hb浓度达到20 g/L;Poly Hb+HES组:将Poly PHb加入到HES溶液中,使Hb浓度为20 g/L;1个假手术组:只做常规手术,不放血不复苏。将大鼠行等容量液体复苏,分别在各组大鼠休克前、后,输液末、输液后1 h、2 h观测大鼠平均动脉压(MAP)、乳酸(Lac)、氧分压(Pa O2)、二氧化碳分压(Pa CO2),并在复苏2 h取各组大鼠肠组织制备成10%组织匀浆,测定丙二醛(MDA)、髓过氧化物酶(MPO)、肿瘤坏死因子(TNF-α)的含量。结果 HES、RBC+HES和Poly Hb+HES 3组大鼠输液后MAP(mm Hg)分别为88.00±9.90 vs 100.57±7.69vs 112.16±17.05(P“0.05);输液后2 h,乳酸(mmol/L)分别为3.71±0.91 vs 2.30±0.97 vs 2.50±0.65(P”0.05),Pa O2(mm Hg)分别为126.5±10.40 vs 111.16±9.64 vs 111.00±13.98(P“0.05),Pa CO2(mm Hg)分别为30.00±3.16 vs 42.66±5.31 vs 34.66±1.50(P”0.05);输液后2 h,RBC+HES、HES组MDA、MPO活性,分别为:0.47±0.34 vs 0.99±0.81,0.23±0.29 vs 0.57±0.32(P“0.05);Poly Hb+HES与HES组MPO活性、TNF-α分别为0.32±0.19 vs 0.57±0.32,89.42±21.03 vs 208.45±62.80(P”0.05)。结论 HES溶液添加多Poly Hb可以改善失血性休克大鼠组织氧供和酸中毒现象,减轻肠组织缺血再灌注损伤。
Objective To investigate the effect of adding PolyHb to hydroxyapatite (HES) solution on intestinal ischemia-reperfusion in rats with severe hemorrhagic shock. Methods 32 SD rats were sacrificed to 60% of systemic blood volume (6.5% body weight). After femoralis and venous cannulation, the animals were bled from the femoral artery until the amount of blood transfused into rat whole body (HES group): 6% HES130 / 0.4 sodium chloride injection; RBC + HES (RBC + HES) Group: Routine centrifugation of the rat’s blood was repeated three times, and the erythrocytes were collected and added into the HES solution to make the Hb concentration reach 20 g / L; Poly Hb + HES group: Poly PHb was added to the HES solution to make the Hb concentration 20 g / L; a sham operation group: only conventional surgery, no bleeding does not recover. Rats were resuscitated with equal volume of liquid. The mean arterial pressure (MAP), lactate (Lac) and partial pressure of oxygen (Pa) were measured at the end of infusion and at the end of infusion and at 1 and 2 h after infusion respectively. O2 and PaCO2. After 2 h of resuscitation, the intestinal tissues of rats in each group were made into 10% tissue homogenates. The levels of malondialdehyde (MDA), myeloperoxidase (MPO), tumor necrosis Factor (TNF-α) content. Results MAP (mm Hg) after infusion in HES, RBC + HES and Poly Hb + HES 3 groups were 88.00 ± 9.90 vs 100.57 ± 7.69 vs 112.16 ± 17.05 (P <0.05) / L) were 3.71 ± 0.91 vs 2.30 ± 0.97 vs 2.50 ± 0.65 (P "0.05), Pa O2 (mm Hg) were 126.5 ± 10.40 vs 111.16 ± 9.64 vs 111.00 ± 13.98 (P <0.05) CO2 (mm Hg) were respectively 30.00 ± 3.16 vs 42.66 ± 5.31 vs 34.66 ± 1.50 (P <0.05). At 2 h after infusion, MDA and MPO activities in RBC + HES and HES groups were 0.47 ± 0.34 vs 0.99 ± 0.81,0.23 ± 0.29 vs 0.57 ± 0.32 (P <0.05). MPO activity and TNF-α in Poly Hb + HES and HES groups were respectively 0.32 ± 0.19 vs 0.57 ± 0.32, 89.42 ± 21.03 vs 208.45 ± 62.80 (P < 0.05). Conclusions The addition of Poly Hb solution to HES solution can improve oxygen supply and acidosis in hemorrhagic shock rats and alleviate intestinal ischemia-reperfusion injury.