Postresuscitation tissue neutrophil infiltration is time-dependent and organ-specific.
Postresuscitation tissue neutrophil infiltration is time-dependent and organ-specific.
复制标题
复苏后组织中性粒细胞浸润具有时间依赖性和器官特异性。
DOI：
10.1016/j.jss.2007.04.008
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Garrison,RichardN
中科院分区：
文献类型：
--
作者：
Zakaria,ElRasheid;Campbell,JamesE;Peyton,JamesC;Garrison,RichardN
常规复苏（CR）的出血性休克引发循环中性粒细胞并激活血管内皮，从而增加全身炎症、超氧化物释放和终末器官损伤。通过腹膜内滴注临床腹膜透析液辅助直接腹膜复苏（DPR）可通过增强组织灌注减少全身炎症和水肿形成。本研究的目的是确定对中性粒细胞和流体sequestration. METHODS麻醉大鼠的影响，40%的平均动脉压为60 min。动物随机CR与返回的棚血加两个体积的生理盐水，或CR加连续性DPR与30 mL的腹膜内注射临床腹膜透析液。组织髓过氧化物酶（MPO）水平，中性粒细胞隔离的标志物，和总水含量进行了评估，在肠道，肺，肝脏在假手术动物和时间点1，2，4，和24 h postresuration.MTS复苏从出血性休克增加MPO水平在所有组织中在复苏后的第一个4小时内以接近线性的方式。无论采用何种复苏方案，都会发生这种情况。组织MPO水平在复苏后24 h恢复至基线水平，但在肝脏中，CR和非连续性DPR引起了显着的反弹增加。与单纯CR相比，辅助DPR可防止CR介导的肠和肺中的强制性液体隔离，并维持这些器官中相对正常的组织水（n = 7，F = 10.1，P < 0.01）。结论：出血性休克和复苏产生时间依赖性的器官特异性中性粒细胞隔离趋势，这与中性粒细胞浸润的标记物髓过氧化物酶的组织水平有关。通过直接腹膜复苏调节内脏血流量并没有改变终末器官中的时间依赖性中性粒细胞浸润，这表明血液流变学在腹腔镜诱导的中性粒细胞隔离中的从属作用。大鼠失血性休克复苏后4h内存在嗜中性粒细胞介导的组织损伤的脆弱窗口期。直接腹膜复苏可防止早期强制性液体隔离，促进早期液体动员。
BACKGROUNDHemorrhagic shock with conventional resuscitation (CR) primes circulating neutrophils and activates vascular endothelium for increased systemic inflammation, superoxide release, and end-organ damage. Adjunctive direct peritoneal resuscitation (DPR) with intraperitoneal instillation of a clinical peritoneal dialysis solution decreases systemic inflammation and edema formation by enhancing tissue perfusion. The aim of this study is to determine the effect of adjunctive DPR on neutrophil and fluid sequestration.METHODSAnesthetized rats were hemorrhaged to 40% mean arterial pressure for 60 min. Animals were randomized for CR with the return of the shed blood plus two volumes of saline, or CR plus adjunctive DPR with 30 mL of intraperitoneal injection of a clinical peritoneal dialysis solution. Tissue myeloperoxidase (MPO) level, a marker of neutrophil sequestration, and total water content were assessed in the gut, lung, and liver in sham animals and at time-points 1, 2, 4, and 24 h postresuscitation.RESULTSResuscitation from hemorrhagic shock increases MPO level in all tissues in a near-linear fashion during the first 4 h following resuscitation. This occurs irrespective of the resuscitation regimen used. Tissue MPO level returned to baseline at 24 h following resuscitation except in the liver where CR and not adjunctive DPR caused a significant rebound increase. Adjunctive DPR prevented the CR-mediated obligatory fluid sequestration in the gut and lung and maintained a relative normal tissue water in these organs compared with CR alone (n = 7, F = 10.1, P < 0.01).CONCLUSIONHemorrhagic shock and resuscitation produces time-dependent organ-specific trends of neutrophil sequestration as measured with tissue levels of myeloperoxidase, a marker of neutrophil infiltration. Modulation of the splanchnic blood flow by direct peritoneal resuscitation did not alter the time-dependent neutrophil infiltration in end-organs, suggesting a subordinate role of blood rheology in the hemorrhage-induced neutrophil sequestration. Vulnerable window for neutrophil-mediated tissue damage exists during the first 4 h following resuscitation from hemorrhagic shock in rats. Direct peritoneal resuscitation prevents the early obligatory fluid sequestration and promotes early fluid mobilization.