【摘要】：目的:觀察不同血紅蛋白濃度對失血性休克兔肺功能的影響,探討重度失血性休克復(fù)蘇時的理想血紅蛋白濃度,進而指導(dǎo)臨床的合理用血。方法:選擇健康雄性新西蘭家兔50只,體重2.0~2.4kg,采用隨機數(shù)字表法分為5組(n=10):C組為對照組,F組為休克復(fù)蘇未輸血組,R組為休克復(fù)蘇輸血組,復(fù)蘇后血紅蛋白濃度(Hb)分別控制在:R1組60 g≤Hb80 g/L、R2組80g≤Hb100 g/L、R3組100g≤Hb120 g/L,每組10只。C組進行股動脈分離并行股動脈測壓,不模擬休克;F組模擬休克后進行液體復(fù)蘇,不輸血;R組模擬休克后進行液體復(fù)蘇并輸注存儲了兩周的濃縮紅細胞,使Hb達到設(shè)定濃度。分別于休克前(T0)、休克后(T1)、復(fù)蘇后即刻(T2)、復(fù)蘇后1h(T3)、復(fù)蘇后2h(T4)、復(fù)蘇后3h(T5)檢測動脈血氣(p H值、氧分壓Pa O2、二氧化碳分壓Pa CO2、乳酸Lac)。用ELISA法檢測各時點血清中炎性因子的含量(IL-6、IL-8、TNF-α)。全程記錄失血量、輸液量和輸血量。實驗結(jié)束后觀察兔肺組織的濕干比、病理變化和細胞凋亡情況,檢測肺組織中髓過氧化物酶(MPO)、一氧化氮(NO)和蛋白(BCA)含量。結(jié)果:(1)五組家兔基礎(chǔ)MAP比較無明顯差異(P0.05)。與T0時比較,F組和R組家兔休克后MAP水平明顯下降(P0.05)。復(fù)蘇后R2與R3組MAP恢復(fù)至基礎(chǔ)水平,R1組和F組復(fù)蘇后MAP值仍低于C組(P0.05)。(2)與T0時比較,T1時R組和F組p H明顯降低(P0.05)。與C組比較,T2時R2和R3組p H恢復(fù)至正常水平,R1組和F組仍降低(P0.05),T3時,R1組和F組也恢復(fù)至正常水平。與T0時比較,T1時R組和F組Pa CO2明顯降低(P0.05)。T2時各組恢復(fù)至正常水平。與C組比較,T3、T4、T5時R1、R3和F組Pa CO2降低,差異有統(tǒng)計學意義(P0.05)。與T0時比較,T1時R組和F組Pa O2明顯升高(P0.05)。T2時,R組Pa O2明顯高于F組(P0.05)。與T0時比較,T1時R組和F組Lac明顯升高(P0.05)。復(fù)蘇后,R組和F組Pa O2明顯降低,各組間比較,F組Lac明顯高于C組和R組,R2組明顯低于R1組、R3組和F組,差異有統(tǒng)計學意義(P0.05)。T5時,R2組Lac恢復(fù)至基礎(chǔ)水平。(3)休克后,R組和F組血漿IL-6、IL-8、TNF-α顯著升高,T2~T5時,R2組各炎癥因子濃度顯著低于F組和R1組,F組和R1組顯著高于C組(P0.05),R2組和R3組比較差異無統(tǒng)計學意義(P0.05)。(4)與C組比較,R組和F組兔肺組織中的MPO、NO、BCA含量顯著升高(P0.05)。R2組MPO、NO、BCA含量顯著低于F組和R1組,R3組MPO、NO、BCA含量顯著低于F組和R1組(P0.05),R2組和R3組比較差異無統(tǒng)計學意義(P0.05)。(5)C組肺泡結(jié)構(gòu)完整,肺泡腔及間隔無中性粒細胞滲出,無擴張融合,肺泡腔清晰;F組可見肺泡間隔增寬,肺泡腔內(nèi)可見粒細胞明顯增多,有的肺泡擴張融合,肺間質(zhì)水腫明顯,R2組較F組和R1組肺泡結(jié)構(gòu)較完整,肺泡腔內(nèi)滲出較少,間質(zhì)水腫也較輕。R2組肺組織濕干比也F組和R1組低(P0.05),R2組和R3組比較沒有明顯差別。(6)TUNEL法檢測各組兔肺組織凋亡發(fā)現(xiàn),F組細胞凋亡明顯,凋亡率較其他組明顯增多,R2組細胞凋亡率小于F組和其他輸血組。結(jié)論:失血性休克進行復(fù)蘇時,不同的輸血量均可造成不同程度的肺損傷;復(fù)蘇后血紅蛋白濃度在80~120 g/L時,可以有效的恢復(fù)機體的血流灌注和氧供;失血性休克復(fù)蘇后Hb濃度維持在80~100 g/L可以減少輸血量,減少輸血后不良反應(yīng)的發(fā)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.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614

【參考文獻】

相關(guān)期刊論文 前10條

1 陳健;王偉;李興慧;施民新;;異體輸血對食管癌患者術(shù)后免疫功能的影響[J];現(xiàn)代腫瘤醫(yī)學;2015年19期

2 黎筆熙;陶軍;朱水波;張曉明;宋曉陽;劉雷霆;殷桂林;;鹽酸戊乙奎醚對失血性休克大鼠急性肺損傷的影響[J];中華實驗外科雜志;2014年11期

3 田蜜;李永軍;楊嬌嬌;紀木火;楊建軍;李偉彥;;限制性輸血與開放性輸血策略對髖關(guān)節(jié)置換術(shù)老年患者預(yù)后的影響[J];臨床麻醉學雜志;2014年05期

4 徐鈞;孟慶和;沈曉覽;郭楓;;術(shù)中不同血紅蛋白濃度對手術(shù)安全和預(yù)后的影響分析[J];中國實驗診斷學;2014年03期

5 濮益琴;;輸血相關(guān)性急性肺損傷研究進展[J];當代護士(下旬刊);2013年02期

6 宋先斌;肖軍;;替米沙坦對大鼠呼吸機相關(guān)性肺損傷的保護作用[J];第三軍醫(yī)大學學報;2012年04期

7 劉鳳華;曹榮垎;祁萍萍;;發(fā)生輸血相關(guān)性急性肺損傷2例報告[J];臨床血液學雜志(輸血與檢驗版);2010年06期

8 金麗艷;徐軍美;賀志飚;劉流;陳艷平;;烏司他丁對大鼠急性肺損傷的保護作用及其機制[J];臨床麻醉學雜志;2007年11期

9 于布為,顧敏杰,薛慶生;急性超容量血液稀釋對氧供、氧耗、循環(huán)血容量和血管外肺水的影響[J];臨床麻醉學雜志;2003年01期

10 孫玲玲;方衛(wèi)平;魯顯福;顧爾偉;;圍術(shù)期輸血相關(guān)急性肺損傷的預(yù)防策略[J];國際麻醉學與復(fù)蘇雜志;2013年03期

，

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