早期限制性液体复苏孕兔失血性休克的疗效评价  

Therapeutic Effect of Initial limited Fluid Resuscitation on Hemorrhagic Shock in Pregnant Rabbits

作　　者：王晨虹[1] 涂新枝[1] 张铨富[1] 余艳红[2] 龚时鹏[2] 胡冬煦[3] 

机构地区：[1]南方医科大学深圳市妇幼保健院,广东深圳518028 [2]南方医科大学南方医院,广东广州510515 [3]中南大学湘雅第二医院,湖南长沙410011

出　　处：《实用妇产科杂志》2008年第3期152-155,共4页Journal of Practical Obstetrics and Gynecology

基　　金：广东省重大社会问题联合攻关项目基金资助(编号:ZKB04701S)

摘　　要：目的:探讨早期限制性液体复苏对重度失血性休克孕兔的治疗效果。方法:15只孕兔制成未控制性重度失血性休克模型,随机分为假休克组(P组)、传统液体复苏组(TFR组)、限制性液体复苏组(LFR组),分别于实验0分钟、30分钟、90分钟、180分钟、4小时检测和比较各组凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原含量(Fbg)和碱缺失(BD)水平,并比较各组72小时孕兔的存活率。结果:急性失血后各组PT、APTT、Fbg未发生明显改变。给予液体复苏后,LFR组实验90分钟、180分钟、4小时时PT、APTT较TFR组明显缩短(P<0.05),但较P组明显延长(P<0.05)。两个治疗组Fbg含量从实验90分钟开始下降,然而LFR组实验180分钟后开始上升(P<0.05)。急性失血后,两个治疗组BD持续增加(负值升高),实验90分钟后,两个治疗组BD程度开始减轻,尤以LFR组下降明显(P<0.05)。P组5只孕兔全部存活超过72小时,LFR组为4只,TFR组为3只。结论:早期限制性液体复苏减轻凝血功能障碍,减少出血量,改善组织灌注和细胞代谢,减轻酸中毒,可能是临床上重度产科失血性休克理想的复苏方案。Objective：To evaluate the therapeutic effect of limited fluid resuscitation on severe hemorrhagic shock in pregnant rabbits models. Methods： The model of severe uncontrolled hemorrhagic shock was established in 15 pregnant rabbits. The rabbits were randomly assigned to pseudo shock group （ P group）, traditional fluid resuscitation group （TFR group）, and limited fluid resuscitation group （LFR group）. We detected and compared the values of prothrombin time （PT）, activated partial prothrombin time （ APTT）, fibrinogen （Fbg） and base deficit （BD） at 0min, 30min, 90min, 180min, 4h. The survival rate of pregnant rabbits on 72h in each group was compared. Results： PT and APTT in three groups did not change significantly after acute blood loss. After fluid resuscitation, PT and APTT in LFR group at 90min, 180min, and 4h were shorter than those in TFR group（ P〈 0.05）, but longer than those in P group（ P〈 0.05）. The content of Fbg in two therapeutic groups decreased since 90min, however, in LFR group it has increased since 180min（ P 〈 0.05）. The BD level in two therapeutic groups increased persistently （negative value rse） after acute blood loss, and it began to decrease since 90min, especially in LFR group（ P〈0.05）. All rabbits in P group survived beyond 72h, as well as 3 rabbits in TFR group and 4 rabbits in LFR group. Conclusions： Initial limited fluid resuscitation can reduce coagulation disorders, decrease blood loss, improve the organs perfusion and cell metabolism, relieve acidosis, increase survival rate. Initial limited fluid resuscitation may bean ideal resuscitation method for severe obstetrical hemorrhagic shock.

关 键 词：限制性液体复苏 失血性休克 治疗效果 

分 类 号：R714[医药卫生—妇产科学]