口服丙酮酸盐糖液对45%血容量失血性休克大鼠血流动力学和组织灌注的影响

doi:10.3877/cma.j.issn.1673-9450.2017.05.003

中华损伤与修复杂志(电子版) ›› 2017, Vol. 12 ›› Issue (05) : 331 -336. doi: 10.3877/cma.j.issn.1673-9450.2017.05.003

所属专题：文献；

论著

口服丙酮酸盐糖液对45%血容量失血性休克大鼠血流动力学和组织灌注的影响

喻文¹, 王吉文¹, 陈亮¹, 胡森², 何志捷¹, 刘锐³^,^†(

)

^1. 510120　广州，中山大学孙逸仙纪念医院重症医学科
^2. 100048　北京，解放军总医院第一附属医院烧伤研究所休克与多器官障碍实验室
^3. 150040　哈尔滨，黑龙江省医院烧伤科

收稿日期:2017-07-26 出版日期:2017-10-01
通信作者: 刘锐
基金资助:
黑龙江省科技厅青年自然基金(QC2016101); 黑龙江省卫计委科研项目(2016-233, 2017-580)

Effects of oral rehydration with pyruvate-glucose-electrolyte solution on hemodynamics and tissue perfusion in resuscitation of hemorrhagic shock in rats with 45% blood volume loss

Wen Yu¹, Jiwen Wang¹, Liang Chen¹, Sen Hu², Zhijie He¹, Rui Liu³^,^†()

^1. Department of Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
^2. Laboratory of Shock and Organ Dysfunction, Burns Institute, First Hospital Affiliated to People′s Liberation Army General Hospital, Beijing 100048, China
^3. Department of Burns, Heilongjiang Provincial Hospital, Harbin 150040, China

Received:2017-07-26 Published:2017-10-01
Corresponding author: Rui Liu
About author:
Corresponding author: Liu Rui, Email: liurui650426@163.com

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引用本文：

喻文, 王吉文, 陈亮, 胡森, 何志捷, 刘锐. 口服丙酮酸盐糖液对45%血容量失血性休克大鼠血流动力学和组织灌注的影响[J/OL]. 中华损伤与修复杂志(电子版), 2017, 12(05): 331-336.

Wen Yu, Jiwen Wang, Liang Chen, Sen Hu, Zhijie He, Rui Liu. Effects of oral rehydration with pyruvate-glucose-electrolyte solution on hemodynamics and tissue perfusion in resuscitation of hemorrhagic shock in rats with 45% blood volume loss[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2017, 12(05): 331-336.

目的

研究口服丙酮酸盐糖液对45%血容量失血性休克大鼠早期血流动力学及组织灌注的影响。

方法

选择雄性SD大鼠作为研究对象，进行胃造瘘置管和股动静脉插管处理，然后依据随机数字表法分为3组：休克不复苏组(NR组，n＝20)，休克口服丙酮酸盐糖液组(PGES组，n＝20)和休克口服碳酸氢盐糖液组(BGES组，n＝20)。以上3组按全身血容量的45%放血处理，每次5 min，间隔15 min。另选择10只大鼠在手术后不放血进行对照研究(NH组，n＝10)。PGES组与BGES组于失血休克后0.5 h经胃造瘘管输入2倍失血量的丙酮酸盐糖液与碳酸氢盐糖液。在失血前、失血后即刻及失血后1、2、4 h各时间点测定各组的平均动脉压(MAP)及肝、肾、肠黏膜血流量相关指标，同时观察分析其失血后24 h内生存情况。对各数据进行F检验、t检验或Kruskal-Wallis秩和检验，生存率分析采用log-rank检验，P<0.05为差异有统计学意义。

结果

NH组24 h内大鼠的存活率为100%，NR组、BGES组和PGES组失血后24 h大鼠的生存率分别为4.2%、20.8%和45.8%，组间比较差异均有统计学意义(P值均小于0.05)。观察发现各组失血性休克大鼠MAP及肝、肾、肠黏膜血流量在失血之后就开始进行性降低；NR组大鼠失血后1 h，MAP有一定幅度地上升，随后持续降低直至死亡；实验结果表明，和NR组相比，BGES组和PGES组大鼠失血后各时间点的MAP及各脏器血流量均有一定幅度的回升，且后者的回升幅度更大，差异均有统计学意义(P值均小于0.05)。

结论

口服丙酮酸盐糖液可显著改善45%血容量失血性休克大鼠的血流动力学及器官灌注指标，且效果优于碳酸氢盐糖液。丙酮酸盐糖口服液复苏可能对失血性休克的治疗提供一定的帮助作用。

关键词: 丙酮酸, 休克，出血性, 补液疗法, 血流动力学, 大鼠, 组织灌注

Objective

To study the effects of oral rehydration with glucose-electrolyte solution containing sodium pyruvate on early hemodynamics and tissue perfusion in hemorrhagic shock rats with 45% blood volume loss.

Methods

Male Sprague-Dawley (SD) rats underwent surgical catheter placements(at sites of stomach, left femoral artery and vein)were divided into three groups by means of random number table: hemorrhagic shock without rehydration (NR group, n=20), hemorrhagic shock and oral administration of pyruvate-glucose-electrolyte solution (PGES group, n=20), hemorrhagic shock and oral administration of bicarbonate-glucose-electrolyte solution (BGES group, n=20). All rats in above three groups were bled about 45% total blood volume in 5 minutes twice with an interval of 15 minutes. Another 10 rats without hemorrhage were followed by a control study (NH group, n=10). Rats in PGES group and BGES group were fed with PGES or BGES at 0.5 h after bleeding by twice of the blood loss volume. The mean arterial pressure (MAP) and organ (liver, kidney and intestinal mucosal) blood flow were measured before bleeding and at 0, 1, 2, 4 h after bleeding, and the mortality within 24 hours was also analyzed. The data were analyzed by F test, t test or Kruskal-Wallis rank test, and the survival rate was analyzed by log-rank test, there was statistical difference with P<0.05.

Results

All rats in NH group were alive at 24 h, and the survival rates within 24 h were 4.2%, 20.8% and 45.8% in the NR group, BGES group and PGES group respectively. There was significant difference between each two groups(with P values below 0.05). The MAP and the organ blood flows were decreased continuously in the rats after bleeding. In NR group, the MAP rose to a certain extent at 1 h after hemorrhage, then consecutively decreasing until death. The experimental results also show that, compared with NR group, the MAP and organ blood flows in rats of BGES group and PGES group both had a certain degree of elevation at each timepoint after hemorrhage, both MAP and organ blood flows in the PGES group were significantly higher than that in the BGES group at 1, 2, 4 h after hemorrhagic shock, the differences were statistically significant (with P values below 0.05).

Conclusions

Oral rehydration with glucose-electrolyte solution containing sodium pyruvate can significantly improve hemodynamics and organ perfusion in 45% blood volume hemorrhagic shock rats, and the effect is better than that of bicarbonate-containing oral rehydration solution. Oral rehydration with pyruvate-glucose-electrolyte solution may play a certain role in the treatment of hemorrhagic shock.

Key words: Pyruvic acid, Shock, hemorrhagic, Fluid therapy, Hemodynamics, Rats, Tissue perfusion

表1 各组大鼠基础参数比较(±s)

分组	鼠数(只)	体重(g)	全身血容量(mL)	补液总量(mL)
NR组	20	259.80±13.11	16.36±0.78	0
PGES组	20	262.52±17.30	16.52±1.03	14.86±0.90
BGES组	20	263.58±17.66	16.59±1.01	14.90±0.92
NH组	10	263.61±16.20	16.61±0.94	0

表1 各组大鼠基础参数比较(±s)

分组	鼠数(只)	体重(g)	全身血容量(mL)	补液总量(mL)
NR组	20	259.80±13.11	16.36±0.78	0
PGES组	20	262.52±17.30	16.52±1.03	14.86±0.90
BGES组	20	263.58±17.66	16.59±1.01	14.90±0.92
NH组	10	263.61±16.20	16.61±0.94	0

表2 各组大鼠45%血容量失血后不同时间点部分生理指标比较(±s)

组别	鼠数(只)	pH值
组别	鼠数(只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	7.345±0.028	7.213±0.062^a	7.111±0.078^ac	6.977±0.059^ac	6.968±0.091^ac
PGES组	20	7.360±0.035	7.167±0.053^a	7.379±0.039^bc	7.344±0.047^bc	7.409±0.059^bc
BGES组	20	7.373±0.034	7.191±0.035^a	7.230±0.076^ab	7.222±0.065^ab	7.115±0.094^ab
NH组	10	7.361±0.043	7.395±0.030^bc	7.378±0.079^bc	7.384±0.047^bc	7.400±0.024^bc
组别	鼠数(只)	HCT(%)
组别	鼠数(只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	45.60±4.64	35.67±4.49^a	33.07±5.60^a	29.77±2.33^a	29.10±1.99^a
PGES组	20	43.60±3.43	36.00±3.45^a	31.77±2.70^a	35.20±2.88^abc	34.90±2.92^abc
BGES组	20	46.90±2.98	38.15±2.22^a	30.68±2.25^a	31.13±1.71^a	30.02±2.05^a
NH组	10	47.38±2.36	46.15±1.78^bc	44.90±3.12^bc	42.27±2.60^abc	42.55±3.19^abc
组别	鼠数(只)	剩余碱(mmol/L)
组别	鼠数(只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	－2.35±0.84	－9.4±2.36^a	－11.48±5.84^a	－12.23±3.43^ac	－15.48±1.67^ac
PGES组	20	－2.73±0.25	－9.45±3.83^a	－5.73±1.12^abc	－4.40±0.77^bc	－1.28±2.46^bc
BGES组	20	－2.58±0.58	－9.02±1.71^a	－11.27±3.16^a	－8.05±1.68^ab	－7.22±1.89^ab
NH组	10	－2.13±0.79	－4.08±0.69^abc	－3.20±1.54^bc	－1.45±1.88^bc	－2.48±0.79^bc
组别	鼠数(只)	乳酸(mmol/L)
组别	鼠数(只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	1.55±0.51	9.05±1.00^a	10.95±3.10^ac	9.37±1.96^a	15.57±3.91^ac
PGES组	20	1.48±0.71	8.70±2.70^a	8.47±2.08^ab	4.48±0.80^abc	1.95±0.61^bc
BGES组	20	1.67±0.54	9.58±2.36^a	8.35±1.50^ab	10.57±3.97^a	6.72±2.11^ab
NH组	10	1.67±0.60	1.60±0.47^bc	1.92±0.29^bc	3.42±1.06^abc	2.50±0.60^abc

表2 各组大鼠45%血容量失血后不同时间点部分生理指标比较(±s)

组别	鼠数(只)	pH值
组别	鼠数(只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	7.345±0.028	7.213±0.062^a	7.111±0.078^ac	6.977±0.059^ac	6.968±0.091^ac
PGES组	20	7.360±0.035	7.167±0.053^a	7.379±0.039^bc	7.344±0.047^bc	7.409±0.059^bc
BGES组	20	7.373±0.034	7.191±0.035^a	7.230±0.076^ab	7.222±0.065^ab	7.115±0.094^ab
NH组	10	7.361±0.043	7.395±0.030^bc	7.378±0.079^bc	7.384±0.047^bc	7.400±0.024^bc
组别	鼠数(只)	HCT(%)
组别	鼠数(只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	45.60±4.64	35.67±4.49^a	33.07±5.60^a	29.77±2.33^a	29.10±1.99^a
PGES组	20	43.60±3.43	36.00±3.45^a	31.77±2.70^a	35.20±2.88^abc	34.90±2.92^abc
BGES组	20	46.90±2.98	38.15±2.22^a	30.68±2.25^a	31.13±1.71^a	30.02±2.05^a
NH组	10	47.38±2.36	46.15±1.78^bc	44.90±3.12^bc	42.27±2.60^abc	42.55±3.19^abc
组别	鼠数(只)	剩余碱(mmol/L)
组别	鼠数(只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	－2.35±0.84	－9.4±2.36^a	－11.48±5.84^a	－12.23±3.43^ac	－15.48±1.67^ac
PGES组	20	－2.73±0.25	－9.45±3.83^a	－5.73±1.12^abc	－4.40±0.77^bc	－1.28±2.46^bc
BGES组	20	－2.58±0.58	－9.02±1.71^a	－11.27±3.16^a	－8.05±1.68^ab	－7.22±1.89^ab
NH组	10	－2.13±0.79	－4.08±0.69^abc	－3.20±1.54^bc	－1.45±1.88^bc	－2.48±0.79^bc
组别	鼠数(只)	乳酸(mmol/L)
组别	鼠数(只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	1.55±0.51	9.05±1.00^a	10.95±3.10^ac	9.37±1.96^a	15.57±3.91^ac
PGES组	20	1.48±0.71	8.70±2.70^a	8.47±2.08^ab	4.48±0.80^abc	1.95±0.61^bc
BGES组	20	1.67±0.54	9.58±2.36^a	8.35±1.50^ab	10.57±3.97^a	6.72±2.11^ab
NH组	10	1.67±0.60	1.60±0.47^bc	1.92±0.29^bc	3.42±1.06^abc	2.50±0.60^abc

图1 45%血容量失血性休克后各组大鼠24 h生存率

图2 各组大鼠45%血容量失血后不同时间点平均动脉压的变化比较

表3 各组大鼠失血后不同时间点脏器血流量的变化比较(PU，±s)

组别	鼠数 (只)	肝表面血流量
组别	鼠数 (只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	489.8±25.3	79.8±9.3^a	121.1±8.8^ac	96.3±7.9^ac	65.3±7.3^ac
PGES组	20	487.9±28.2	78.5±10^a	227.1±14.2^abc	253.1±14.9^ab	319.9±23.4^abc
BGES组	20	484.9±28.3	78.6±10.2^a	210.4±16.6^ab	252.6±15.1^ab	154±14.9^ab
NH组	10	482.9±27.6	481.7±27.6^ab	481.1±26^bc	470.8±32.7^bc	478.5±25.5^bc
组别	鼠数 (只)	肾表面血流量
组别	鼠数 (只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	964.7±22.8	157.3±18.6^a	447.3±24.1^a	232.2±24.5^ac	168.9±26.9^ac
PGES组	20	966.9±19.5	153.5±14.5^a	521.8±21.3^abc	531±23.6^abc	546.6±21.8^abc
BGES组	20	964.1±20	156.7±19^a	435.2±23.9^a	415.9±15.3^ab	287.9±22.2^ab
NH组	10	965.1±21	955.6±19.4^bc	958.5±21.7^bc	958.3±22.9^bc	960.2±23.5^bc
组别	鼠数 (只)	肠黏膜血流量
组别	鼠数 (只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	157.3±16.5	8.0±2.1^a	37.9±9.2^ac	16.8±1.5^ac	15.5±4.4^ac
PGES组	20	153.1±17.2	8.7±2.6^a	81.2±8.9^abc	108.3±13.9^abc	125±15.8^abc
BGES组	20	158.3±14.6	8.9±1.9^a	75.4±7.4^ab	93.8±13.3^ab	50.1±13.3^ab
NH组	10	158.0±11.4	155.8±10.5^bc	156±11^bc	156.5±11^bc	153.8±10.5^bc

表3 各组大鼠失血后不同时间点脏器血流量的变化比较(PU，±s)

组别	鼠数 (只)	肝表面血流量
组别	鼠数 (只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	489.8±25.3	79.8±9.3^a	121.1±8.8^ac	96.3±7.9^ac	65.3±7.3^ac
PGES组	20	487.9±28.2	78.5±10^a	227.1±14.2^abc	253.1±14.9^ab	319.9±23.4^abc
BGES组	20	484.9±28.3	78.6±10.2^a	210.4±16.6^ab	252.6±15.1^ab	154±14.9^ab
NH组	10	482.9±27.6	481.7±27.6^ab	481.1±26^bc	470.8±32.7^bc	478.5±25.5^bc
组别	鼠数 (只)	肾表面血流量
组别	鼠数 (只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	964.7±22.8	157.3±18.6^a	447.3±24.1^a	232.2±24.5^ac	168.9±26.9^ac
PGES组	20	966.9±19.5	153.5±14.5^a	521.8±21.3^abc	531±23.6^abc	546.6±21.8^abc
BGES组	20	964.1±20	156.7±19^a	435.2±23.9^a	415.9±15.3^ab	287.9±22.2^ab
NH组	10	965.1±21	955.6±19.4^bc	958.5±21.7^bc	958.3±22.9^bc	960.2±23.5^bc
组别	鼠数 (只)	肠黏膜血流量
组别	鼠数 (只)	失血前	失血后即刻	失血后1 h	失血后2 h	失血后4 h
NR组	20	157.3±16.5	8.0±2.1^a	37.9±9.2^ac	16.8±1.5^ac	15.5±4.4^ac
PGES组	20	153.1±17.2	8.7±2.6^a	81.2±8.9^abc	108.3±13.9^abc	125±15.8^abc
BGES组	20	158.3±14.6	8.9±1.9^a	75.4±7.4^ab	93.8±13.3^ab	50.1±13.3^ab
NH组	10	158.0±11.4	155.8±10.5^bc	156±11^bc	156.5±11^bc	153.8±10.5^bc

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13	Ojha S,Goyal S,Kumari S, et al. Pyruvate attenuates cardiac dysfunction and oxidative stress in isoproterenol-induced cardiotoxicity[J]. Exp Toxicol Pathol, 2012, 64(4): 393-399.

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Effects of oral rehydration with pyruvate-glucose-electrolyte solution on hemodynamics and tissue perfusion in resuscitation of hemorrhagic shock in rats with 45% blood volume loss

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Effects of oral rehydration with pyruvate-glucose-electrolyte solution on hemodynamics and tissue perfusion in resuscitation of hemorrhagic shock in rats with 45% blood volume loss