血液滤过对中暑休克犬血清酶和内毒素的影响

中华急诊医学杂志2012年8月第21卷第8期Chin J Emerg Med,August 2012,Vol.21,No.8

P830-835

【摘要】目的 探讨血液滤过（HF）对中暑休克犬血清酶（SE）、内毒素（ET）和丙二醛（MDA）的影响。方法 16只健康雄性杂种犬，随机分为中暑对照组（heat stroke，HS组）和中暑后血液滤过治疗组(HF组)各8只。采用整体高温来诱导犬重症中暑休克，中暑休克模型成功后立即出舱，HS组置于常温下观察，HF组立即行血液滤过治疗。观察2组犬SE、ET和MDA变化及存活时间。结果 HS组和HF组热暴露达到休克的时间分别为（107.00±28.52） min和（111.38±22.24）min（t=-0.354，P=0.729）。中暑时两组犬血清酶（CK、LDH、ALT、AST）均较中暑前明显升高（P＜0.01），两组之间比较差异具有统计学意义（P>0.05）；中暑后3 h内HS组血清酶继续明显上升，HF组亦有缓慢上升，但上升幅度明显低于HS组。HS组和HF组中暑前血清内毒素比较，差异无统计学意义（P>0.05）；中暑时血清内毒素明显高于中暑前（P＜0.01），且两组之间比较，差异无统计学意义（P>0.05）；中暑后3 h内HS组内毒素继续明显上升，而HF组亦有缓慢上升，但上升幅度明显低于HS组。HS组和HF组中暑前血清丙二醛比较，差异无统计学意义（P>0.05）；中暑时HS组和HF组血清丙二醛明显高于中暑前（P＜0.01），且两组之间比较，差异无统计学意义（P>0.05）；中暑后3 h内HS组丙二醛继续明显上升，而HF组逐渐下降。HF组中位生存期为180 min ，HS组为75 min，两组生存率比较，较差异具有统计学意义（P＜0.01）。结论 血液滤过能够改善中暑休克犬的预后，延长其存活时间，减少病死率。其机制可能与清除血清MDA、部分清除血清内毒素，并最终减轻组织细胞的损伤和降低血清酶有关。

【关键词】犬；中暑；休克；血液滤过；血清酶；内毒素；丙二醛；生存率

Effects of hemofiltration on serum enzyme and endotoxin of dogs with heat stroke caused shockCHEN Guang-ming, XU Hui-na, GAO Li-fang, Wang Cheng-feng,LU Jin-fu, WANG Wen-rui, CHEN Jin-hua，CHEN Jian. Department of Pediatrics,Fuzhou General Hospital of Nanjing Military Command，Fuzhou 350025, China

Corresponding author：CHEN Jian, Email：,

【Abstract】Objective To explore the effects of hemofiltration on serum enzyme(SE)，endotoxin(ET) and malonaldehyde(MDA) of dogs with heat stroke caused shock.Methods Sixteen healthy male hybrid dogs were randomly divided into 2 groups, 8 for each：as heat stroke group（HS group）and hemofiltration group（HF group）. Severe heat stroke model was induced with high temperature. The dogs were taken out of the heating cabin when it reached heat stroke level, and then observed under normal temperature without treatment. The dogs in HF group was immediately treated with hemofiltration. The changes of SE, ET, MDA of two groups of dogs were observed and the survival time between two groups was compared. Results The time from heat exposure to shock was（ 107.00±28.52）and （111.38±22.24）minutes in HS group and HF group respectively （t=-0.354，P=0.729）. The SE (CK, LDH, ALT, AST) of the dogs were all higher after heat stroke, and the dogs of two groups showed no siginificant difference (P>0.05). At three hours after heat stroke, the SE increased apparently in HS group and HF group, but the level was significantly lower in HF group. Before heat stroke, the serum ET showed no siginificant difference between two groups (P>0.05). After heat stroke, the serm ET was much higher than before (P＜0.01), but there was still no siginificant difference between two groups (P>0.05). At three hours after heat stroke, the ET increased both in HF group and HS group, but the level was lower in HF group. Before heat stroke, the serm MDA had no siginificant difference between two groups (P>0.05). After heat stroke, the serm MDA was much higher than before (P＜0.01), but there was still no siginificant difference between two groups(P>0.05). After heat stroke in three hours, the MDA of HS group rose apparently while HF group slowly declined. The median survival time of HF group was 180 min while HS group was 75 min, the survival rate showed siginificant difference(P＜0.01). Conclusions HF can improve the prognosis of dogs with heat stroke caused shock, prolong its survival time, reduce mortality. The mechanism is probably that HF clear serum MDA, partially clear serum ET and then eventually reduce cell and tissue injury and reduce SE.