摘要目的 探讨辅助腹腔复苏(adjunct peritoneal resuscitation,APR)对大鼠失血性休克早期肝损伤的治疗作用及可能机制.方法 96只雄性Wistar大鼠按随机数字法分成对照组、休克组、林格液APR组(APR1组)和透析液APR组(APR2组),每组再分为复苏后1、2、6h3个时点,每个时点8只大鼠.复制失血性休克动物模型.休克组采用常规静脉复苏(回输失血+2倍失血量的生理盐水);APR1组和APR2组在常规静脉复苏基础上,分别于开始复苏液体时一次性腹腔注射100 mL/kg林格液或2.5％葡萄糖腹膜透析液.各组于相应时点处活杀大鼠,检测肝功能、计算肝组织湿/干质量比(W/D)、镜下观察肝组织病理改变,以RT-PCR法检测肝组织NF-κB、HSP70 mRNA表达,采用SPSS 16.0软件进行统计分析.结果 与休克组及APR1组比较,APR2组复苏后各时点肝组织HSP70 mRNA表达显著增强(P＜0.05),而2h和6 h W/D比值、复苏后6h内肝病理损伤程度及各时点血清ALT和AST水平、NF-κB mRNA表达均明显降低(P＜0.05).结论 2.5％葡萄糖腹透液APR可减轻失血性休克早期肝损伤,其作用机制可能与增强肝组织HSP70mRNA表达、抑制NF-κB mRNA表达有关.

abstractsObjective To investigate the therapeutic effect of adjunct peritoneal resuscitation (APR) on the early hepatic injury in rats with hemorrhagic shock in order to explore its possible mechanisms.Methods Ninety-six male Wistar rats were assigned randomly (random number) into control group, shock group, APR1 group and APR2 group.Each group was further divided into 3 subgroups (n =8 in each) as per the animals sacrificed separately at 1 h, 2 h, and 6 h after resuscitation.The rat model of hemorrhagic shock was made by exsanguination under amytal anesthesia and heparinization.The rats in shock group received shed blood plus twice amount of normal saline as conventional intravenous resuscitation (CIR).Besides CIR, at the beginning of resuscitation, those rats in APR1 and APR2 groups were administered intra-peritoneally with 100 mL/kg of Ringer's solution or 2.5％ glucose-based peritoneal dialysis solution, respectively.The shock rats in the four groups were sacrificed separately at above mentioned intervals after resuscitation.Liver enzymes and wet/dry weight ratio (W/D) of liver tissue were measured, and pathological changes of liver tissue were observed under optic microscope.The expressions of NF-κB and hot shock protein-70 (HSP70) mRNA in the liver tissue of rats were detected with RT-PCR.All data were statistically analyzed using SPSS 16.0 software.Results Compared with the shock group and APR1 group, the expressions of HSP70 mRNA in the liver tissue of rats at all given intervals after resuscitation in APR2 group increased significantly (P ＜ 0.05), but the W/D ratios of liver tissue at 2 h, 6 h, the degree of pathological changes of liver tissue in 6 h, serum levels of ALT and AST at all given intervals and the expressions of NF-κB mRNA at all given intervals decreased significantly (P ＜ 0.05).Conclusions APR with 2.5％ glucose-based peritoneal dialysis solution can significantly mitigate the early hepatic injury secondary to hemorrhagic shock, and the mechanisms may be associated with enhancement the expressions of HSP70 mRNA and inhibition the expressions of NF-κB mRNA.