犬内毒素性休克时琥珀明胶和乳酸钠林格氏液的容量动力学  

Volume kinetics of gelatin and Ringer＇s lactate solution during septic shock in dogs

作　　者：嵇富海[1] 杨建平[1] 蒋豪[2] 薛张纲[2] 

机构地区：[1]苏州大学附属第一医院麻醉科,215006 [2]复旦大学附属中山医院麻醉科

出　　处：《中华麻醉学杂志》2007年第11期1003-1006,共4页Chinese Journal of Anesthesiology

摘　　要：目的比较犬内毒素性休克时琥珀明胶和乳酸钠林格氏液的容量动力学。方法健康杂种犬20只,雌雄不拘,随机分为4组（n=10）,乳酸钠林格氏液组（CL组）经30min静脉输注乳酸钠林格氏液30ml/kg;琥珀明胶组（CG组）经30min静脉输注琥珀明胶10ml/kg;内毒素＋乳酸钠林格氏液组（LL组）静脉注射内毒素250μg/kg,再经30min静脉输注乳酸钠林格氏液30ml/kg;内毒素＋琥珀明胶组（LG组）静脉注射内毒素250μg/kg,再经30min静脉输注琥珀明胶10ml/kg。补液期间每隔5分钟测定血红蛋白浓度和红细胞压积;记录血液动力学指标和总尿量。应用物质守恒定律和容量动力学理论,计算血浆容量增加、外周容量增加、容量扩张效率、目标容积（V）和清除率（Kr）。结果与CL组比较,CG组V和Kr降低,LL组V升高（P〈0.05）;与CG组比较,LG组V和Kr升高（P〈0.05）;与LL组比较,LG组V和K降低（P〈0.05）。与CG组和LG组比较,CL组和LL组血浆容量增加和容量扩张效率降低,外周容量增加升高（P〈0.05）;与CL组和CG组比较,LL组和LG组血浆容量增加和容量扩张效率降低,外周容量增加升高（P〈0.05）。结论犬内毒素性休克时,乳酸钠林格氏液的扩容效率较琥珀明胶降低更为明显。Objective To study the time course of distribution and elimination of the fluid infused during endotoxemia using volume kinetics and mass balance, trying to optimize fluid therapy. Methods Twenty mongrel dogs of both sexes weighing 11-19 kg were used in this study. Each animal underwent experiments twice at an interval of at least on week. The animals were anesthetized, tracheostomized and mechanically ventilated. Right femoral artery was cannulated for MAP monitoring. Swan-Ganz catheter was placed via right external jugular vein for monitoring of CVP, CO and CI. The animals were divided randomly into 2 groups （ n = 10 each） . Each animal underwent experiment in 2 phases. In the first phase group Ⅰ received Ringer＇s lactate solution （LR） 30 ml/kg （CL） and groupⅡ received gelatin 10 mg/kg （CG） . In the second phase group Ⅲ and Ⅳ received first LPS 250 μg/kg and then LR 30 ml/kg （group LL） or gelatin 10 ml/kg （group LG） was infused over 30 min. Hb and Hct were measured every 5 min and urine output every 10 min from the beginning of fluid infusion to the end of each experiment. The distribution and elimination of the fluid infused were studied by volume kinetics based on serial analysis of hemoglobin dilution in arterial blood and by mass balance. Increase in blood volume and peripheral blood volume, volume expansion efficiency and target blood volume （V） and clearance rate （Kr ） were calculated. Results （1） The one-volume kinetic model parameters： V and Kr were significantly smaller in CG, LG groups than in CL, LL groups. The size of V in LL group was the largest in all groups. The V and Kr were significantly larger in LG group than in CG group. （2） The calculated values based on mass balance corresponded to the predicted values based on volume kinetics. The VEE and change in central volume were significantly greater in LG and CG groups than in LL and CL groups. The change in peripheral volume（CPV） in LL group was the largest, The CPV was significantly larger

关 键 词：明胶 乳酸钠 动力学 休克 脓毒性 

分 类 号：R686[医药卫生—骨科学]