卡巴胆碱对失血性休克犬口服补液时胃排空和胃血流量影响的研究  

Effects of carbachol on gastric emptying and mucosal blood flow in oral resuscitation of hemorrhagic shock

作　　者：李琳[1] 蒋纤[1] 侯经元[2] 胡森[2] 

机构地区：[1]解放军总医院304临床部麻醉科,北京100036 [2]解放军总医院烧伤研究所休克与多器官障碍实验室,北京100036

出　　处：《中华临床医师杂志（电子版）》2011年第8期2182-2185,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的研究卡巴胆碱对失血性休克口服补液时胃排空和胃血流量的影响。方法成年雄性Beagle犬12只,先期无菌手术行颈总动脉、颈外静脉和胃内置管,24h后按全身血容量的42%放血制作失血性休克模型。随机分为口服补液组(n=6)和卡巴胆碱组(n=6)。失血后第1个24h口服补液组和卡巴胆碱组分别从胃管输入3倍失血量的葡萄糖-电解质溶液和溶有卡巴胆碱(20μg/kg)的葡萄糖-电解质溶液。失血后24h起两组均给予静脉补液。测定犬失血前(0h)和失血后2h、4h、8h和24h非麻醉状态下的胃黏膜血流量(GMBF);伤后30min应用电阻抗断层成像法检测胃排空变化,同时观察胃不耐受症状。结果卡巴胆碱组胃排空率显著高于口服补液组(P<0.05),胃对口服液的不耐受症状明显减轻。两组犬GMBF失血后较0h均显著减少(P<0.05),但卡巴胆碱组GMBF显著多于口服补液组(P<0.05)。结论重度失血性休克口服补液时给予卡巴胆碱能促进胃排空,增加GMBF,提高口服补液的治疗效果。Objective To investigate the effects of carbachol on gastric emptying and muscosal blood flow with dogs in oral fluid resuscitation of hemorrhagic shock.Methods Twelve male Beagle dogs were surgically prepared for cannulation of carotid and jugular vein,and gastrostomy,24 hours later they were subjected to a hemorrhagic shock of loss of 42% total blood volume.The dogs were randomized to oral resuscitation group(OR)and oral resuscitation plus carbachol group(OR/CAR).Either a glucose-electrolyte solution(GES)or GES containing CAR(20 μg/kg)were intragastrically given to animals in OR group or OR/CAR group.The delivery volume of GES was three times volume of blood loss within 24 h after bleeding.Dogs in each group were given intravenous fluid resuscitation from 24 h after hemorrhage.The gastric mucosal blood flow(GMBF)was determined before hemorrhage(0 h)and 2,4,8 and 24 h after hemorrhage at no anesthesia state.Gastric emptying rate was measured by detecting of the radioactivity of intragastric 99mTc-DTPA.Gastric intolerance symptom was also observed.Results Gastric emptying rate in OR/CAR group obviously higher than that in OR group after hemorrhage.Gastric intolerance symptom was significantly decreased in OR/CAR group compared to OR group.The levels of GMBF in each group were significantly lowered after bleeding,but these in OR/CAR group were obviously higher than those in OR group(P<0.05).Conclusions The results indicated that carbachol improved oral resuscitation effect of severe hemorrhagic shock by promoting gastric empty and increasing GMBF.

关 键 词：休克 出血性 补液疗法 卡巴胆碱 胃排空 

分 类 号：R644[医药卫生—外科学]