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目的了解胰岛素强化治疗对重度烫伤大鼠心肌的保护作用,并探讨其作用机制。方法将18只SD大鼠分为3组,每组6只。强化组及烫伤组大鼠背部脱毛造成30%TBSA的Ⅲ度烫伤。强化组伤后即输注胰岛素等渗盐水(含胰岛素0.12 U/ml)及100 g/L葡萄糖,使大鼠血糖水平控制在4.0～6.6 mmol/L之间,补液总量为2 m1.kg~(-1)·%TBSA~(-1)·8 h~(-1);烫伤组伤后仅给予等渗盐水,总量同前。假伤组模拟烫伤,伤后补充生理量的液体。于伤前及伤后1、2、3、4、5、6 h抽取大鼠静脉血测定其血糖值。各组大鼠伤后均经右颈动脉插管入左心室并连接生理记录仪,观察左心室收缩压(LVSP)及左心室舒张末期压(LVEDP)。伤后6 h,处死各组大鼠,留取左心室组织标本用于心肌细胞肌钙蛋白T的检测。结果烫伤组大鼠伤后1～6 h的血糖值为(7.6±1.7)～(8.4±4.7) mmol/L,均高于强化组[(4.5±0.9)～(5.2±1.3)mmol/L,P<0.01]。伤后1 h,烫伤组LVSP [(60±11)mm Hg(1 mm Hg=0.133 kPa)]降低、LVEDP[(21.3±11.3)mm Hg]升高,与强化组[(72±8)、(11.7±5.2)mm Hg]比较,差异有统计学意义(P<0.05)。烫伤后各组大鼠肌钙蛋白T在心肌细胞内大量缺失,而强化组缺失程度明显低于烫伤组(P<0.05)。结论胰岛素强化治疗对重度烫伤大鼠左心室功能具有明显的保护作用,此作用可能与抑制心肌细胞蛋白的缺失有关。
Objective To investigate the protective effect of intensive insulin therapy on myocardium of severely scalded rats and its mechanism of action. Methods 18 SD rats were divided into 3 groups, 6 in each group. The third-degree scald of 30% TBSA caused by the back hair removal in the intensive and scalded rats. In the intensive group, the rats were infused with insulin isotonic saline (containing 0.12 U / ml insulin) and 100 g / L glucose, and the blood glucose level was controlled between 4.0 and 6.6 mmol / L in the intensive group. The total volume of infusion was 2 m1.kg ~ (-1)% TBSA ~ (-1) · 8 h ~ (-1); the scald group was given isotonic saline only after the injury, with the same amount as before. Mock injury group simulated burns, after the injury to add a reasonable amount of liquid. Blood samples were collected from venous blood before injury and 1,2,3,4,5,6 h after injury. After injury, rats in each group were intubated into the left ventricle through the right carotid artery and connected to a physiological recorder. Left ventricular systolic pressure (LVSP) and left ventricular end-diastolic pressure (LVEDP) were observed. 6 h after injury, each group of rats was sacrificed, left ventricular tissue samples were collected for the detection of cardiac troponin T. Results The blood glucose level in the burn group was (7.6 ± 1.7) ~ (8.4 ± 4.7) mmol / L from 1 to 6 h after injury, which were significantly higher than those in the intensive group [(4.5 ± 0.9) ~ (5.2 ± 1.3) mmol / L , P <0.01]. At 1 h after injury, LVSP [(60 ± 11) mm Hg (1 mm Hg = 0.133 kPa)] decreased and LVEDP [(21.3 ± 11.3) mm Hg] (11.7 ± 5.2) mm Hg], the difference was statistically significant (P <0.05). After scald, the troponin T in each group was largely absent in the myocardial cells, but the extent of the deficiency in the intensive group was significantly lower than that in the scalded group (P <0.05). Conclusion Intensive insulin therapy has a significant protective effect on left ventricular function in severely scalded rats, which may be related to the inhibition of myocardial protein loss.