早期应用去甲肾上腺素的液体复苏方案对脓毒性休克大鼠肺脏的作用(4)
本研究结果中脓毒性休克组肺组织中代表氧化损伤程度的羟自由基、MDA及MPO水平较对照组明显升高，而反映体内还原能力的SOD水平明显下降，早期应用去甲肾上腺素仅使MPO表达下降，而对羟自由基、MDA及SOD表达无明显改善。提示在液体复苏过程中，大量补液及血管活性药物的使用虽然改善了微循环，但此时可能形成了一个缺血-再灌注状态，大量氧自由基生成，从而加重了氧化性损伤。因此在液体复苏过程中选择适当的抗氧化剂可能会进一步改善脓毒性休克及所致ALI的预后。
参考文献
[1]Ware LB， Matthay MA. The acute respiratory distress syndrome[J]. N Engl J Med， 2000， 342(18)：1334-1349.
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, 百拇医药
[3] Martin GS， Mannino DM， Eaton S， et al. The epidemiology of sepsis in the United States from 1979 through 2000 [J].N Engl J Med， 2003， 348(16)：1546-1554.
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[6] Trzeciak S， McCoy JV， Phillip Dellinger R， et al. Early increases in microcirculatory perfusion during protocol directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis [J]. Intensive Care Med， 2008， 34(12)：2210-2217.
, 百拇医药
[7] Alan E， Jones MD. Prospective external validation of the clinical effectiveness of an emergency department-based early goal directed therapy protocol for severe sepsis and septic shock [J]. CHEST， 2007， 132(2)：425-432.
[8] Mitchell JP， Schuller D， Calandrino FS， et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization [J]. Am Rev Respir Dis， 1992， 145(5)：990-998.
, 百拇医药 [9] Schrier RW. Fluid administration in critically ill patients with acute kidney injury[J]. Clin J Am Soc Nephrol， 2010， 5(4)：733-739.
[10]Sennoun N， Montemont C， Gibot S， et al. Comparative effects of early versus delayed use of norepinephrine in resuscitated endotoxic shock [J]. Crit Care Med， 2007， 35(7)：1736-1740.
[11] Julie A， Lorraine B， Gordon R. The role of the coagulation cascade in the continuum of sepsis and acute lung injury and acute respiratory distress syndrome [J].Semin Respir Crit Care Med， 2006， 27(4)：365-376.
, 百拇医药
[12] Dellinger RP， Levy MM， Carlet JM， et al. Surviving Sepsis Campaign： international guidelines for management of severe sepsis and septic shock： 2008[J]. Intensive Care Med， 2008， 34(1)：17-60.
[13] Gao F， Melody T， Daniels DF， et al.The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis：a prospective observational study[J].Crit Care， 2005， 9(61)：764-770.
[14] Vatner SF， Braunwald E. Cardiovascular control mechanisms in the conscious state[J]. N Engl J Med， 1975， 293(19)：970-976.
, http://www.100md.com
[15] Landry DW， Oliver JA. The pathogenesis of vasodilatory shock[J]. N Engl J Med， 2001， 345(8)：588-595.
[16] Rothe CF， Gaddis ML. Autoregulation of cardiac output by passive elastic characteristics of the vascular capacitance system [J]. Circulation， 1990， 81(1)：360-368.
[17] Shapiro NI， Howell MD， Talmor D， et al. Serum lactate as a predictor of mortality in emergency department patients with infection [J]. Ann Emerg Med， 2005， 45(5)：524-528.
, 百拇医药
[18] Keel M， Trentz O. Pathophysiology of Polytrauma[J]. Injury， 2005， 36(6)： 691-709.
(收稿日期：2012-06-14)
(本文编辑：何小军)
DOI：10.3760/cma.j.issn.1671-0282.2013.02.007
基金项目：国家自然科学基金(81101415)
作者单位：110001 沈阳，中国医科大学附属第一医院急诊科
通信作者：刘志，Email： liuzhicmu2004@yahoo.com.cn
P136-P140
, 百拇医药(刘伟 刘志)
参考文献
[1]Ware LB， Matthay MA. The acute respiratory distress syndrome[J]. N Engl J Med， 2000， 342(18)：1334-1349.
[2] Angus DC， Linde-Zwirble WT， Lidicker J， et al. Epidemiology of severe sepsis in the United States： analysis of incidence outcome and associated costs of care[J]. Crit Care Med， 2001， 29(7)：1303-1310.
, 百拇医药
[3] Martin GS， Mannino DM， Eaton S， et al. The epidemiology of sepsis in the United States from 1979 through 2000 [J].N Engl J Med， 2003， 348(16)：1546-1554.
[4] 吴在德.外科学[M].北京：人民卫生出版社，2002：44-45.
[5] Rivers E， Nguyen B， Havstad S， et al. Early goal directed therapy in the treatment of severe sepsis and septic shock [J]. N Engl J Med， 2001， 345(19)：1368-1377.
[6] Trzeciak S， McCoy JV， Phillip Dellinger R， et al. Early increases in microcirculatory perfusion during protocol directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis [J]. Intensive Care Med， 2008， 34(12)：2210-2217.
, 百拇医药
[7] Alan E， Jones MD. Prospective external validation of the clinical effectiveness of an emergency department-based early goal directed therapy protocol for severe sepsis and septic shock [J]. CHEST， 2007， 132(2)：425-432.
[8] Mitchell JP， Schuller D， Calandrino FS， et al. Improved outcome based on fluid management in critically ill patients requiring pulmonary artery catheterization [J]. Am Rev Respir Dis， 1992， 145(5)：990-998.
, 百拇医药 [9] Schrier RW. Fluid administration in critically ill patients with acute kidney injury[J]. Clin J Am Soc Nephrol， 2010， 5(4)：733-739.
[10]Sennoun N， Montemont C， Gibot S， et al. Comparative effects of early versus delayed use of norepinephrine in resuscitated endotoxic shock [J]. Crit Care Med， 2007， 35(7)：1736-1740.
[11] Julie A， Lorraine B， Gordon R. The role of the coagulation cascade in the continuum of sepsis and acute lung injury and acute respiratory distress syndrome [J].Semin Respir Crit Care Med， 2006， 27(4)：365-376.
, 百拇医药
[12] Dellinger RP， Levy MM， Carlet JM， et al. Surviving Sepsis Campaign： international guidelines for management of severe sepsis and septic shock： 2008[J]. Intensive Care Med， 2008， 34(1)：17-60.
[13] Gao F， Melody T， Daniels DF， et al.The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis：a prospective observational study[J].Crit Care， 2005， 9(61)：764-770.
[14] Vatner SF， Braunwald E. Cardiovascular control mechanisms in the conscious state[J]. N Engl J Med， 1975， 293(19)：970-976.
, http://www.100md.com
[15] Landry DW， Oliver JA. The pathogenesis of vasodilatory shock[J]. N Engl J Med， 2001， 345(8)：588-595.
[16] Rothe CF， Gaddis ML. Autoregulation of cardiac output by passive elastic characteristics of the vascular capacitance system [J]. Circulation， 1990， 81(1)：360-368.
[17] Shapiro NI， Howell MD， Talmor D， et al. Serum lactate as a predictor of mortality in emergency department patients with infection [J]. Ann Emerg Med， 2005， 45(5)：524-528.
, 百拇医药
[18] Keel M， Trentz O. Pathophysiology of Polytrauma[J]. Injury， 2005， 36(6)： 691-709.
(收稿日期：2012-06-14)
(本文编辑：何小军)
DOI：10.3760/cma.j.issn.1671-0282.2013.02.007
基金项目：国家自然科学基金(81101415)
作者单位：110001 沈阳，中国医科大学附属第一医院急诊科
通信作者：刘志，Email： liuzhicmu2004@yahoo.com.cn
P136-P140
, 百拇医药(刘伟 刘志)