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内毒素血症、细胞因子在失血性休克发展过程中的作用及治疗对策

来源:中国急救医学 作者:朱华栋综述周玉淑审校 2004-9-29
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摘要: 失血性休克是临床上较常见的危重症之一,主要的治疗手段是补充血容量、应用升压药物等。但是有些患者即使血容量已被补足,升压药用到了极量,休克仍不能得到纠正,最终发展至死亡。因此,顽固性休克的治疗成为临床上的一大难点,彻底弄清休克的发病机制是进行针对性治疗的关键。近年来,人们对于细菌及内毒素移位、细胞因......


  2.4 对抗细胞因子的治疗 采用细胞因子的抗体来中和细胞因子,从而减轻细胞因子对机体的损害,已引起许多学者的关注。在动物重度失血性休克模型中,应用TNFα单抗可以中和循环中的TNFα,降低TNFα mRNA的表达,能有效地防止多器官功能障碍,降低动物死亡率[19]。在动物实验中,应用IL-1受体拮抗剂(IL-1RA)可以阻断IL-1对组织损伤作用[20],应用IL-6的单抗可以使大鼠在遭受以致命的大肠杆菌感染时以及在予以致死量的TNFα时得以存活[21]。给予IL-8的单抗能够防止中性粒细胞介导的组织渗透和损伤[22]。

  失血性休克的发生发展是很复杂的病理过程,有许多因素参与其中。依靠单一因素来解释其全貌是不可能的。由于休克引起了脏器的血流灌注不足,从而诱发了包括肠道细菌、内毒素移位,大量炎性细胞因子的合成、释放等在内的诸多不良反应,最终导致各脏器功能不全,发展成不可逆休克。因此,在临床失血性休克的治疗过程中,应采取具体的针对性措施来对抗上述不良因素,这可能是将来预防和治疗顽固性失血性休克的一个突破方向。

参考文献

  [1]Yao YM, Tian HM, Wang YP, et al. Protective effect of Re-LPS antiserum on experimental multiple system organ failure. Chin Med J, 1992, 105: 833-838.

  [2]Jiang JX, Bahrami S, Leichtfried G,et al. Kinetics of endotoxin and tumorsis factor appearance in protal and system circulation after hemorrhagic shock in rats. Ann Surg, 1995, 221(1): 100-106.

  [3]Sorol AJ, Rush BF, Lysz TW, et al. The gut as sorese of sepsis after hemorrhgic shock. Am J Surg, 1988, 155: 187-192.

  [4]Chang TW. Improvement of survival from hemorrhagic shock by enterectomy in rats: finding to implicate the role of the gut for irreversibillty of hemorrhagic shock. J Trauma, 1997, 42: 223-230.

  [5]Rush BF,Sori AJ, Murphy TF, et al. Endotoxemia and bacteremia during hemorrhagic shock. Ann Surg, 1988, 207: 549-544.

  [6]Rush BF. Irreversibility in hemorrhagic shock is caused by sepsis. Am Surg, 1989, 55: 204.

  [7]Antonsson JB, et al. The role of the gut in shock and multiple system organ failure: clinical review. Eur J Surg, 1991, 157: 3.

  [8]Stoutenbeek CP, Van Saene HKF, Miranda DR, et al. The effect of Selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Inten Care Med, 1984, 10: 185.

  [9]Kasravi FB, Adawi D, Molin G, et al. Effect of oral supplementation of lactobacilli on bacterial translocation in acute liver injury induced by Dgalactosamine. J Hepatol, 1997, 26: L417-424.

  [10]Bahrami S, Yao YM, Leichtfried G, et al. Monoclonal antibody to endotoxin attenuates hemorrhage-induced lung injury and mortality in rats. Crit Care Med, 1997, 25: 1030-1036.

  [11]Weiss J, Olsson I. Cellular and subcellular localization of the bactericidal/permeability increasing protein of neutrophils. Blood, 1987, 69: 652-659.

  [12]Marra MN, Wilde CG, Griffith JE, et al. Bactericidal/permeability-increasing protein has endotoxin-neutralizing activity. J Immunol, 1990, 144: 662-668.

  [13]Yao YM, Bahrami S, Leichtfried G, et al. Pathogensis of hemorrhage-induced bacteria/endotoxin translocation in rats: Effects of recombinant bactericidal-increasing protein(rBPI21). Ann Surg, 1995, 221: 398-405.

  [14]姚咏明,田惠民,王亚军,等.大鼠出血性休克后肠源性内毒素血症及TNF、IL-1变化的动态观察.中国病理生理杂志,1993,9(5):585-589.

  [15]Yao YM, Tian HM, Sheng ZY, et al. Inhibitory effects of low-dose polymyxin B on hemorrhage-induced endotoxin/bacterial translocation and cytokine formation. J Trauma, 1995, 38: 924-930.

  [16]蒋建新,田昆仑,陈惠孙,等.家兔创伤性休克后血浆内毒素、TNF和IL-6的动态变化.中华麻醉学杂志,1997,17(3):171-173.

  [17]Couturier C, Jahns G, Haeffner-Cavaillon N, et al. Membrane molecules which trigger the production of interleukin-1 and tumor necrosis factor-alpha by lipopolysaccharide-stimulated human monocytes. Eur J Immunol, 1992, 22: 1461-1466.

  [18]Heumann D, Gallay P, Barras C, et al. Control of lipopolysaccharide (LPS) binding and LPS-induced tumor necrosis factor secretion in human peripheral blood monocytes. J Immunol, 1992, 148: 3505-3512.

  [19]姚咏明,陈劲松,于燕,等.延迟应用TNF-α单抗治疗重度失血性休克的实验.中华麻醉学杂志,1998,18(8):486-489.

  [20]Pruitt JH, Copeland EMI, Moldawer LL. Interleukin-1 and interleulkin-1 antagonism in sepsis, systemic inflammation response syndrome, and septic shock. Shock, 1995, 3: 235-251.

  [21]Starnes HF Jr, Pearce MK, Tewari A, et al. Anti-IL-6 monoclonal antibodies protect against lethal escherichia coli infection and lethal tumor necrosis facfor-α challenge in mice. J Immunol, 1990, 145: 4185-4191.

  [22]Harada A, Sekido N, Akahoshi T, et al. Essential involvement of interleukin-8(IL-8) in acute inflammation. J Leukoc Biol 1994; 56: 559-564.


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