腹部血管损伤非控制性休克分阶段早期液体复苏  

The early liquid resuscitation of uncontrolled hemorrhagic shock in staged abdominal aorta injury

作　　者：杨鹤鸣[1] 李荣[1] 徐迎新[1] 

机构地区：[1]解放军总医院普通外科研究所暨野战外科研究所,北京100853

出　　处：《中华急诊医学杂志》2008年第4期375-379,共5页Chinese Journal of Emergency Medicine

摘　　要：目的非控制性失血性休克（UHS）怎样进行液体复苏，目前尚无一致意见。本实验制作了腹部血管损伤UHS模型，并根据战创伤实际将模型分为四个阶段，探索早期液体复苏方案。方法sD大鼠40只，左股动、静脉及左心室插管。开腹，于腹主动脉中下段用25G针头穿刺造成活动性出血。模拟战创伤实际，将动物分为受伤早期、早期救助期、后期救治期及观察期四个阶段。分组：①无复苏组：不进行液体复苏。②早期不复苏组：早期不复苏，后期救治期给予3倍腹腔出血量的林格氏液在15min快速输入。③早期快速复苏组：于早期救助期在15min快速输入45ml／kg的林格氏液，后期救治期输液同前。④假手术组。监测血压（MAP）、中心静脉压（CYP）及血乳酸及红细胞比容（Her）等，统计腹腔出血量及存活时间。结果血管损伤后15min动物血压由94．3mmHg下降到25．8mmHg（P〈0．01），早期快速复苏组血压快速升高，但也很快下降。CVP变化与MAP相似。血乳酸在伤后均显著升高，4h可达原来的3～4倍（P〈0．01）。早期快速复苏及后期液体复苏后均导致Het显著下降，并可以使血液乳酸水平的升高明显延缓。早期快速复苏动物腹腔出血量显著增加（由22．8ml／kg增加到27．7ml／kg，P〈0．05）。无复苏组、早期不复苏组及院前快速复苏组动物平均存活时间为分别为50min、120min及93min，三组动物分别在24h、48h及72h内全部死亡。各组之间死亡率差异无统计学意义（P〉0．05）。结论腹部血管伤非控制性失血陛休克早期快速输液不能有效减少乳酸含量、稳定增加全身循环血量以及保持正常血压，反而导致腹腔出血量增加、红细胞比容下降，最终不能延长存活时间、增加生存率。Objective To study the early resuscitation with intravenous administration of hquor in uncontrolled hemorrhagic shock model by four-staged abdominal aorta injury in rats in order to settle the controversy over the issue of volume resuscitation. Method Forty Sprague-Dawley rats were canulated with catheters into the left ventricle, femoral artery and femoral vein, respectively. Animals were subjected to vascular injury of infrarenal pierced with a 25G needle leading to uncontrolled hemorrhagic shock. After aorta injury, the models were processed into 4 stages： early injured stage, early rescue stage, delayed rescue stage and observation stage. The animals were assigned to 4 groups. ①nonresuscitation; ②resuscitation with delayed rescue with lactated Ringer＇ s solution in total amount of 15 times blood loss rapidly infused in 15 minutes; ③resuscitation with preliminary rescue with rapid infusion of 45 ml/kg lactated Ringer＇ s solution in 15 minutes in the early stage and the followed rescue in the late stage; and （4） sham-rescued. The MAP, CVP, lactic acid and Hct were monitored. The volume of blood loss and the survival time of rats were recorded too. Results After aorta injury, The MAP dropped from 94.3 mmHg to 25.8 mmHg and rised quickly after early resuscitation with rapid infusion of liquor and then again fell soon, and CVP did likewise, Lactic acid was increased and reached 3-4 times of baseline at 4 h in all group except Sham-resuced group. The Hct levels decreased quickly after resuscitation with liquor in early rescue stage and delayed rescue stage. The blood loss in abdomen increased after rapid infusion of lactated Ringer＇ s solution in early rescue stage （ blood loss increased from 22.8 ml/kg to 27.7ml/kg, P 〈 0.05 ）. There was no significant difference in mortality between those groups. Conclusions Rapid volume resuscitation at early stage of abdominal aorta injured with uncontrolled hemorrhagic shock cannot increase the circulatory blood volume for maintaining stable blood press

关 键 词：失血性休克 非控制性 腹部血管损伤 液体复苏 

分 类 号：R656.1[医药卫生—急诊医学]