应盼 杨志辉 蔡旗旗 张盛 吴先龙

[摘要] 目的 探討失血性休克（HS）患者在发病期间脏器损伤特点及褪黑素（MT）的保护作用机制。 方法 选取2015年1月至2019年1月浙江省台州市第一人民医院收治的105例HS患者进行分组实验，建立Excel数据库，将所有患者的休克前后的各项数据进行处理，比较其器官功能（心、肝、肾）损伤特点。并探讨MT在其临床治疗中的保护作用及其机制。 结果 ①休克前A、B、C三组的氧供、氧耗比较，差异均无统计学意义（P>0.05），休克后C组低于B组，B组低于A组，差异有统计学意义（P<0.05）。②休克前，A、B、C三组的MAP、CO、CI比较，差异均无统计学意义（P>0.05），休克后三组MAP、CO、CI均低于休克前，差异有统计学意义（P<0.05），且C组低于B组，B组低于A组，差异有统计学意义（P<0.05）。③休克前三组AST、ALT及CREA比较，差异均无统计学意义（P>0.05），休克后三组AST、CREA均高于休克前，差异有统计学意义（P<0.05），三组休克前后ALT比较，差异均无统计学意义（P>0.05），休克后C组AST低于B组，B组低于A组，差异有统计学意义（P<0.05）。④休克后A组MPO、TNF-α含量低于B、C两组，B组又高于C组，差异有统计学意义（P<0.05）。⑤三组休克前NF-κB活性极低，休克发生后便迅速递增，直至休克后6 h达到峰值，而8 h后仍维持在较高水平。休克后A组NF-κB活性高于B组，B组高于C组，差异有统计学意义（P<0.05）。 结论 HS患者的各脏器功能均会受损，受损程度与相关指标升降程度有关，褪黑素良好的保护作用及机制对减少HS患者脏器损伤有较好的价值，可科学、合理地应用。

[关键词] 失血性休克;脏器损伤特点;褪黑素;保护作用机制

[中图分类号] R331          [文献标识码] A          [文章编号] 1673-9701（2021）07-0017-05

The features of organ injury during onset period in patients with hemorrhagic shock and its mechanism of melatonin of the protective effect

YING Pan   YANG Zhihui   CAI Qiqi   ZHANG Sheng   WU Xianlong

Emergency Room， the First People′s Hospital of Taizhou City in Zhejiang Province， Taizhou   318000， China

[Abstract] Objective To investigate the features of organ injury during onset period in patients with hemorrhagic shock （HS） and the protective effect and mechanism of melatonin（MT）. Methods From January 2015 to January 2019， a total of 105 patients with HS admitted to the First People′s Hospital in Taizhou City of Zhejiang Province were selected for grouping experiments. Excel database was established， and used to process all the data before and after the shock. Meanwhile， the features of organ function（cardiac， hepatic and renal） injury were compared. Then， the protective effect and main mechanism of MT in its clinical treatment were analyzed. Results（1）Before shock， there were no statistically significant differences in DO2 and VO2 among the three groups A， B and C（P>0.05）. While after shock， they were lower in group C than in group B， and lower in group B than in group A（P<0.05）.（2） Before shock， there were no statistically significant differences in MAP， CO and CI among groups A， B and C（P>0.05）. While after shock， the above three indexes were all lower than those before shock（P<0.05）， Meanwhile， they were lower in group C than in group B， and lower in group B than in group A（P<0.05）. （3）There were no statistically significant differences in AST， ALT and CREA before shock among the three groups（P>0.05）， while AST and CREA after shock were all higher than those before shock（P<0.05）. ALT among the three groups was not significantly different before and after shock（P>0.05）. After shock， AST in group C was lower than that in group B， and that in group B was lower than that in group A（P<0.05）. （4）After shock， the contents of MPO and TNF-α in group A were lower than those in group B and C， while those in group B were higher than that in group C（P<0.05）. （5）The activity of NF-κB among the three groups was extremely low before shock， and increased rapidly after shock， reaching its peak at 6 h after shock， and remained at a high level after 8 h. After shock， the activity of NF-κB in group A was higher than that in group B， and that in group B was higher than that in group C（P<0.05）. Conclusion Every organ function of HS patients will be injured， and the injury degree is related to the ascending and descending degree of related indexes. MT′s good protective effect and mechanism have better value in reducing organ injury of HS patients， and they should be applied scientifically and reasonably.

[Key words] Hemorrhagic shock; Features of organ injury; Melatonin; Protective effect mechanism

休克（Shock）的发生因素较多，如心脏功能障碍、失血、感染及严重创伤等，多是在机体遭受强烈的致病因素侵袭后机体有效循环血量锐减，导致全身微循环功能不良、生命重要器官严重障碍等综合征候群[1]。失血性休克（Hematogenic shock，HS）作为休克的主要分型之一，在急诊科常见、多发。常见病因与血容量不足以超越代偿功能及大量出血有关[2]。大量临床实验表明，HS发病期间由于血量减少，致使机体内部内循环紊乱和器官功能损伤，故准确了解和获取HS发病期间的脏器损伤特点对治疗有帮助。褪黑素（Melatonin，MT）主要是在松果腺中以色氨酸为基质而合成，有广泛的病理生理功能。有研究发现，MT不仅参与昼夜节律及生殖、甲状腺、肾上腺等功能，其在免疫调节、抗肿瘤、抗氧化等[3]方面还具有较好的效果，当然因其对休克有较好的保护作用而用于HS或相关疾病的治疗。故本……