内毒素休克后家兔血管低反应性的变化规律及其与血流动力学变化的关系  

Changes of vascular hyporeactivity following endotoxic shock in rabbits and its relation with hemodynamic changes

作　　者：陈玮[1] 李涛[1] 杨光明[1] 徐竞[1] 刘良明[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所第二研究室创伤烧伤与复合伤国家重点实验室,重庆400042

出　　处：《重庆医学》2007年第22期2254-2256,共3页Chongqing medicine

基　　金：国家重大基础研究项目资助(973)(2005CB522601)。

摘　　要：目的了解内毒素休克后血管反应性的变化规律及其与血流动力学变化的关系。方法将10只家兔用于测定内毒素休克后的血流动力学变化,另外48只随机分为6组,依次为正常对照组、给LPS后0.5、1、2、4、6h组,分别测定各组肠系膜上动脉(SMA)离体血管环对NE、Ach的收缩和舒张反应性。结果家兔LPS(1mg/kg)静注后,MAP在静注LPS后早期就迅速下降,继而保持平缓的下降趋势;反映心肌收缩功能的左室最大收缩压(LVSP)、左室内压最大上升速率(+dp/dt max)及下降速率(-dp/dt max)等指标先迅速下降然后有一定的回升继而再平稳下降,而左室舒张末压(LVEDP)则没有明显变化;SMA血管环对NE的反应性在早期无显著变化,晚期显著降低;SMA血管环对Ach的反应性在早期升高,晚期下降。结论内毒素休克血管反应性呈现早期高舒张反应、晚期低收缩反应的规律。早期心肌收缩功能的显著下降和血管的高舒张反应可能共同参与了早期MAP的迅速下降;晚期的低收缩反应可能参与了晚期持续性低血压的发生。Objective To explore the changes of vascular reactivity following endotoxic shock and its relation with hemodynamic changes. Methods 10 rabbits were used to observe the changes of hemodynamics following endotoxic shock; another 48 rabbits were divided into 6 groups as follows： normal control group, and 0.5,1,2,4,6h group following LPS injection, and the superior mesenteric arterys from every group were adopted to assay the vascular contraction and relaxation reactivity to NE and Ach. Results Following lmg/kg LPS intravenous injection, mean artery pressure （MAP） was decreased quickly in the early period, then kept on decreasing smoothly, the hemodynamic parameters, including maximum left ventricle systolic pressure （LVSP）, maximum increase and decrease rate of left intraventricular pressure （±dp/dt max）, were decreased quickly after LPS injection and increased a little later, then kept on decreasing smoothly, while left Ventricle end-diastolic pressure （LVEDP） didn’t change obviously. SMA vascular rings＇ reactivity to NE had no significant change in the early period, but decreased obviously in the later period. SMA vascular rings＇ reactivity to Ach was increased significantly in the early period,but showed significant hyporeactivity in the later period. Conclusion Vascular reactivity following endotoxic shock shows hyper-relaxation-reactivity in the early period and hypo-contraction-reactivity in the later period. Significant decrease of cardiac contractility and vascular hyper-relaxation-reactivity in the early period may involve the quick decrease of MAP in the early period after LPS injection, while vascular hypo-contraction-reactivity in the later period may involve in the persistent hypotention in the later period after LPS injection.

关 键 词：内毒素休克 脓毒性休克 血流动力学 血管反应性 

分 类 号：R459.7[医药卫生—急诊医学]