不同血红蛋白浓度对失血性休克兔肺功能的影响

发布时间：2018-10-10 06:34

【摘要】：目的:观察不同血红蛋白浓度对失血性休克兔肺功能的影响,探讨重度失血性休克复苏时的理想血红蛋白浓度,进而指导临床的合理用血。方法:选择健康雄性新西兰家兔50只,体重2.0~2.4kg,采用随机数字表法分为5组(n=10):C组为对照组,F组为休克复苏未输血组,R组为休克复苏输血组,复苏后血红蛋白浓度(Hb)分别控制在:R1组60 g≤Hb80 g/L、R2组80g≤Hb100 g/L、R3组100g≤Hb120 g/L,每组10只。C组进行股动脉分离并行股动脉测压,不模拟休克;F组模拟休克后进行液体复苏,不输血;R组模拟休克后进行液体复苏并输注存储了两周的浓缩红细胞,使Hb达到设定浓度。分别于休克前(T0)、休克后(T1)、复苏后即刻(T2)、复苏后1h(T3)、复苏后2h(T4)、复苏后3h(T5)检测动脉血气(p H值、氧分压Pa O2、二氧化碳分压Pa CO2、乳酸Lac)。用ELISA法检测各时点血清中炎性因子的含量(IL-6、IL-8、TNF-α)。全程记录失血量、输液量和输血量。实验结束后观察兔肺组织的湿干比、病理变化和细胞凋亡情况,检测肺组织中髓过氧化物酶(MPO)、一氧化氮(NO)和蛋白(BCA)含量。结果:(1)五组家兔基础MAP比较无明显差异(P0.05)。与T0时比较,F组和R组家兔休克后MAP水平明显下降(P0.05)。复苏后R2与R3组MAP恢复至基础水平,R1组和F组复苏后MAP值仍低于C组(P0.05)。(2)与T0时比较,T1时R组和F组p H明显降低(P0.05)。与C组比较,T2时R2和R3组p H恢复至正常水平,R1组和F组仍降低(P0.05),T3时,R1组和F组也恢复至正常水平。与T0时比较,T1时R组和F组Pa CO2明显降低(P0.05)。T2时各组恢复至正常水平。与C组比较,T3、T4、T5时R1、R3和F组Pa CO2降低,差异有统计学意义(P0.05)。与T0时比较,T1时R组和F组Pa O2明显升高(P0.05)。T2时,R组Pa O2明显高于F组(P0.05)。与T0时比较,T1时R组和F组Lac明显升高(P0.05)。复苏后,R组和F组Pa O2明显降低,各组间比较,F组Lac明显高于C组和R组,R2组明显低于R1组、R3组和F组,差异有统计学意义(P0.05)。T5时,R2组Lac恢复至基础水平。(3)休克后,R组和F组血浆IL-6、IL-8、TNF-α显著升高,T2~T5时,R2组各炎症因子浓度显著低于F组和R1组,F组和R1组显著高于C组(P0.05),R2组和R3组比较差异无统计学意义(P0.05)。(4)与C组比较,R组和F组兔肺组织中的MPO、NO、BCA含量显著升高(P0.05)。R2组MPO、NO、BCA含量显著低于F组和R1组,R3组MPO、NO、BCA含量显著低于F组和R1组(P0.05),R2组和R3组比较差异无统计学意义(P0.05)。(5)C组肺泡结构完整,肺泡腔及间隔无中性粒细胞渗出,无扩张融合,肺泡腔清晰;F组可见肺泡间隔增宽,肺泡腔内可见粒细胞明显增多,有的肺泡扩张融合,肺间质水肿明显,R2组较F组和R1组肺泡结构较完整,肺泡腔内渗出较少,间质水肿也较轻。R2组肺组织湿干比也F组和R1组低(P0.05),R2组和R3组比较没有明显差别。(6)TUNEL法检测各组兔肺组织凋亡发现,F组细胞凋亡明显,凋亡率较其他组明显增多,R2组细胞凋亡率小于F组和其他输血组。结论:失血性休克进行复苏时,不同的输血量均可造成不同程度的肺损伤;复苏后血红蛋白浓度在80~120 g/L时,可以有效的恢复机体的血流灌注和氧供;失血性休克复苏后Hb浓度维持在80~100 g/L可以减少输血量,减少输血后不良反应的发生。
[Abstract]:Objective: To observe the effect of different hemoglobin concentration on pulmonary function of hemorrhagic shock rabbits. Methods: 50 healthy male New Zealand rabbits were randomly divided into 5 groups (n = 10): C group as control group, group F was shock resuscitation without transfusion group, R group was shock resuscitation transfusion group, and hemoglobin concentration (Hb) after resuscitation was controlled in: Group R1, 60 g, Hb 80 g/ L, R2 group 80g, Hb100 g/ L, R3 group 100g, Hb120g/ L, each group 10 rats. In group C, the femoral artery was isolated from the femoral artery to measure the pressure and did not simulate the shock; the F group underwent resuscitation without blood transfusion after simulated shock; the R group underwent liquid resuscitation after simulated shock, and the concentrated red blood cells were stored for two weeks, so that the Hb reached the set concentration. After resuscitation (T0), after shock (T1), immediately after resuscitation (T2), 1h (T3) after resuscitation, 2h after resuscitation (T4), arterial blood gas (p H value, oxygen partial pressure Pa O2, carbon dioxide partial pressure Pa CO2, lactic acid Lac) were detected at 3h (T5) after resuscitation. The levels of inflammatory factors (IL-6, IL-8, TNF-VEP) in serum were measured by ELISA. Total blood loss, transfusion volume and blood transfusion volume were recorded in the whole process. At the end of the experiment, the wet dry ratio, pathological changes and apoptosis were observed in rabbit lung tissue, and the contents of MPO, NO and BCA in lung tissue were detected. Results: (1) There was no significant difference in MAP between five groups (P0.05). Compared with T0, the MAP level in F group and R group decreased significantly after shock (P0.05). After resuscitation, MAP recovered from MAP to base level, and MAP value was still lower in R1 and F groups than in group C (P0.05). (2) Compared with T0, the p H of group R and F decreased significantly (P <0.05). Compared with group C, the p H of R2 and R3 groups recovered to normal level at T2, and the R1 and F groups were still lower (P0.05), and at T3, R1 and F groups were also restored to normal level. Compared with T0, the CO2 in group R and F group decreased significantly (P0.05). Compared with group C, the CO 2 decreased in group T3, T4 and T5, and the difference was statistically significant (P0.05). Compared with T0, the value of PaO2 in group R and F group was higher than that of group F (P0.05). Compared with T0, the Lac in group R and group F increased significantly at T1 (P0.05). After resuscitation, the PaO2 of group R and F group decreased significantly. Compared with group C and group R, group F Lac was significantly lower than group C and group R, R2 group was lower than group R1, R3 group and group F, and the difference was statistically significant (P0.05). (3) After shock, the levels of IL-6, IL-8, TNF-and IL-6, IL-8, TNF-VEP in group R and group F were significantly higher than those of group F and R1 in group F, group F and R1 in group F, group F and group R1 were significantly higher than those in group C (P0.05). (4) Compared with group C, the content of MPO, NO and BCA in lung tissue of R group and F group increased significantly (P <0.05). The content of MPO, NO and BCA in R2 group was significantly lower than that of group F and R1, and MPO, NO and BCA content in group R were significantly lower than those in group F and R1 (P0.05). There was no significant difference between R2 and R3 groups (P0.05). (5) The alveolar structure of the group C was complete, the alveolar cavity and the interval were free from infiltration of neutrophils, there was no dilation and fusion, the alveolar cavity was clear, the alveolar space was widened in the F group, the visible granulocytes in the alveolar cavity were obviously increased, and the pulmonary interstitial edema was obvious. In R2 group, the alveolar structure of group F and R1 was more complete, and there was less bleeding in the alveolar cavity and the interstitial edema was lighter. The wet dry ratio of lung tissue in R2 group was lower than that in group F and R1 (P0.05), and there was no significant difference between R2 group and R3 group. (6) The apoptosis rate of group F was obviously higher than that in other groups, and the apoptosis rate of R2 group was lower than that of group F and other blood transfusion group. Conclusion: In the resuscitation of hemorrhagic shock, different levels of blood transfusion can cause different levels of lung injury; when the concentration of hemoglobin after resuscitation is 80-120g/ L, the blood flow perfusion and oxygen supply of the body can be effectively restored; the Hb concentration after resuscitation after hemorrhagic shock is maintained at 80-100 g/ L, and the blood transfusion volume can be reduced, and the occurrence of adverse reactions after blood transfusion is reduced.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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