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目的探讨游离血红蛋白(FHb)对猪失血性休克的损伤作用。方法制作创伤失血性休克动物模型,随机分为休克+自体血复苏组(A组)、休克自体血复苏+输注10mg/kgHb(B组)、休克自体血复苏+输注15mg/kgHb(C组)、休克自体血复苏+输注20mg/kgHb(D组)、休克自体血复苏+输注25mg/kgHb(E组)。模型完成后,分别于复苏后的0、6、12、24、48h时间点测定血浆FHb、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、血肌酐(Cr)、尿素(BUN)水平。48h后处死动物,取肝、肾组织做光镜检查。结果A组FHb水平无显著变化;休克复苏中输入FHb,血浆FHb水平持续升高至6h达峰值;B、C组在复苏后24h,D组在复苏后48h血浆FHb回复至初始水平;E组复苏48h血浆FHb仍维持较高水平。D组ALT、AST水平在复苏后12、24h;TBIL、Cr水平在复苏后6、12、24h;BUN水平在复苏后6、12、24、48h;E组ALT、AST、TBIL、Cr水平在复苏后6、12、24h;BUN水平在复苏后6、12、24、48h均显著增高(P<0.05);B、C组肝肾功能指标水平无明显变化。病理结果:光镜下观察,A、B、C、D4组肝脏组织无明显损伤,E组可见肝细胞变性、坏死;大量枯否细胞增生、变形;A、B2组肾脏组织无明显损伤,C组肾小管内皮水肿,呈纤毛状改变,管腔狭窄,有蛋白管型和细胞管型,D组较C组严重,较E组为轻,E组可观察到肾小管变性、坏死。结论复苏时输注高剂量Hb(20—25mg/kg),可加重休克对肝、肾功能及组织结构的损伤。
Objective To investigate the effect of free hemoglobin (FHb) on hemorrhagic shock in pigs. Methods Animal models of traumatic hemorrhagic shock were randomly divided into shock + autologous blood resuscitation group (A), shock autologous blood resuscitation + infusion of 10 mg / kg Hb (group B), shock autologous blood resuscitation + infusion of 15 mg / kg Hb Group), shock autologous blood resuscitation + infusion of 20mg / kgHb (group D), shock autologous blood resuscitation + infusion of 25mg / kgHb (group E). After the model was completed, the levels of plasma FHb, AST, ALT and total bilirubin were measured at 0, 6, 12, 24 and 48 h after resuscitation respectively TBIL), serum creatinine (Cr), urea (BUN) levels. 48h after the animals were sacrificed, liver and kidney tissue taken light microscopy. Results There was no significant change in FHb level in group A; FHb was input during shock resuscitation, the level of FHb in plasma continued to rise to peak at 6h; in group B and C at 24h after resuscitation, plasma FHb in group D returned to the initial level 48h after resuscitation; Plasma FHb maintained a high level 48h after resuscitation. The levels of ALT, AST in group D were 12 and 24 h after resuscitation; the levels of TBIL and Cr were at 6, 12 and 24 h after resuscitation; the level of BUN was 6, 12, 24 and 48 h after resuscitation; the levels of ALT, AST, TBIL and Cr in group E were At 6, 12 and 24 hours after resuscitation, the level of BUN was significantly increased at 6, 12, 24 and 48 hours after resuscitation (P <0.05). There was no significant change in liver and kidney function in B and C groups. Pathological results: Under light microscopy, the liver tissues of groups A, B, C and D4 showed no significant damage. In group E, degeneration and necrosis of liver cells were observed. A large number of Kupffer cells proliferated and deform. No significant damage was observed in group A and B2 Group of renal tubular endothelial edema, ciliary changes, stenosis, protein tube and cell tube type, D group than C group was severe, lighter than E group, E group can be observed tubular degeneration and necrosis. Conclusion High dose of Hb (20-25mg / kg) during resuscitation can aggravate the damage of liver and renal function and tissue structure.