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目的观察早期液体复苏对严重烫伤大鼠肝脏脂肪变性的治疗效果。方法选择健康成年SD大鼠144只,随机分为4组。麻醉后假伤组背部给予30％TBSA的模拟烫伤。其余大鼠背部给予30％TBSAⅢ度烫伤,之后分为单纯烫伤组:烫伤后不补液;早期复苏组:烫伤后立即按Park- land公式用复方乳酸钠林格液进行复苏;延迟复苏组:烫伤后6 h给予液体复苏,方法同早期复苏组。分别于伤后0．5、1．0、2．0、3．0、7．0及21．0 d取各组大鼠肝脏组织,利用光学显微镜、透射电镜观察其病理变化。在相同时相点采集大鼠下腔静脉血,检测血浆总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)、碱性磷酸酶(ALP)的含量。分别于采血前测量各组大鼠体重,采血后取完整肝组织称重并计算肝重:体重比值。进行统计学相关分析。结果早期复苏组大鼠肝细胞脂肪变性程度明显轻于其余两烫伤组。大鼠伤后各时相点TC、TG、ALP的含量按早期复苏组、延迟复苏组、单纯烫伤组顺序依次增高,HDL的含量依次降低。伤后大鼠肝重:体重比值升高,伤后1．0 d延迟复苏组与早期复苏组比较差异有统计学意义(P<0．05);伤后7．0 d,单纯烫伤组、延迟复苏组与早期复苏组比较,差异有统计学意义(P<0．01)。严重烫伤后肝脏脂肪变性程度与HDL含量呈显著负相关(r= -0．37,P<0．01),与ALP含量呈显著正相关(r=0．45,P<0．01),与TG含量呈显著正相关(r= 0．25,P<0．01),与肝重:体重比值呈显著正相关(r=0．44,P<0．01)。其他指标与烫伤后肝脏脂肪变性程度无相关性。结论及时有效的液体复苏可以减轻烫伤大鼠肝脏脂肪变性的严重程度,降低其发生率,有利于促进肝细胞损害的尽早恢复。
Objective To observe the therapeutic effect of early liquid resuscitation on hepatic steatosis in severely scalded rats. Methods 144 healthy adult SD rats were randomly divided into 4 groups. The back of the anesthesia dummy injury group was given 30% TBSA simulated burns. The remaining rats were given a 30% TBSA degree scald on the back, then divided into simple scald group: no scald after rehydration group; early resuscitation group: immediately after scald by Park-land formula with compound sodium lactate Ringer’s solution; delayed resuscitation group: 6 h liquid resuscitation, the method of early recovery group. The liver tissues of rats in each group were taken at 0.5,1.0,2.0,3.0,7.0 and 21.0 d after injury, respectively. The pathological changes were observed by light microscopy and transmission electron microscopy. The inferior vena cava blood was collected at the same time point to detect the levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), and alkaline phosphatase (ALP) The body weight of each group was measured before blood sampling. The whole liver tissues were weighed after blood sampling and the liver weight-to-weight ratio was calculated. Statistical analysis. Results The degree of hepatocellular steatosis in early resuscitation group was significantly lower than that in the other two scalded groups. The levels of TC, TG and ALP at each time point after injury in rats were increased in order of early resuscitation, delayed resuscitation and simple scalding, and the levels of HDL decreased in turn. Compared with the early resuscitation group, the post-injury 1.0 d delayed resuscitation group showed significant difference (P <0.05); at the post-injury 7.0 d, in the scalded group, Delayed resuscitation group and early resuscitation group, the difference was statistically significant (P <0.01). There was a significant negative correlation between the degree of hepatic steatosis and HDL level after severe scald (r = -0.37, P <0.01), and a significant positive correlation with ALP level (r = 0.45, P <0.01) (R = 0.25, P <0.01), and had significant positive correlation with liver weight and body weight (r = 0.44, P <0.01). Other indicators have no correlation with degree of hepatic steatosis after scald. Conclusions A timely and effective liquid resuscitation can reduce the severity of steatosis and reduce the incidence of steatosis in liver of rats and promote the early recovery of liver cell damage.