活动性出血休克家兔的限制性液体复苏  

The effects of resuscitation with limited fluid on rabbits with uncontrolled hemorrhagic shock

作　　者：王振杰[1] 郑士友[1] 王飞[1] 陈前芬[2] 

机构地区：[1]蚌埠医学院第一附属医院急诊外科,安徽省蚌埠233000 [2]蚌埠医学院第一附属医院病理生理教研室,安徽省蚌埠233000

出　　处：《中华急诊医学杂志》2009年第2期154-157,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨有活动性出血的失血性休克家兔对不同剂量平衡盐溶液复苏的疗效。方法用股动脉放血方法复制活动性出血的家兔休克模型，40只成年家兔随机分成5组（n=8）：不输液对照组（N4组），大剂量液体复苏组（125mL／kg，N3组），中剂量液体复苏组（92mL／kg，N2组），小剂量液体复苏组（57mL/kg，N1组），假手术对照组（N5组）。抽血使各实验组动物平均动脉压降至40mmHg，并维持30min，然后用不同剂量平衡盐溶液复苏，再观察动物120mm或直至动物死亡，记录各组动物活动性出血量、死亡数、血细胞比容（Hct）、平均动脉压（MAP）的变化以及肾脏皮质SOD活性。数据分析采用SNK-q检验和秩和检验。结果N5组的各项指标均优于N1，N2，N3组（P〈0．01）；N4组的各项指标均劣于N1，N2，N3组（P〈0．01）；N3组的出血量、死亡数明显高于N1，N2组（P〈0．01）。N3组的SOD明最低于N1和N2组（P〈0．01）。随着复苏液体量的增加，Hct逐渐减小，观察期内N2，N3，N4组MAP逐渐下降，死亡数增加。结论对有活动性出血的失血性休克机体，应行限制性液体复苏（57～92mL/kg）。Objective To investigate the effects of resuscitation with limited fluid on rabbits with uncontrolled hemorrhagic shock. Method Uncontrolled hemorrhagic shock was produced in 40 rabbits. When the mean arterial pressure dropped to 40 mmHg and maintained for 30 minutes, resuscitation was initiated with Ringer solution infusion into rabbits in large volume for group N3 （125 mL/kg）, moderate volume for group N2 （92 mL/kg） and small amount for group N1 （57 mk/kg）, and a drop of fluid was not given to rabbits of group N4. Besides, rabbits of group N5 were controls without shock. MAP, fatality, volume of blood loss, SOD and Hct were observed for 120 minutes or until death. Data were analyzed using SNK- q test and rank test. Results MAP, SOD and Het were higher, and fatality and blood loss were lower in group N5 than those in groups N1, N2, and N3 （P 〈 0.01 ）. MAP,fatality,blood loss and Hct of group N4 were worse than those of groups N1 ,N2 and N3 （P 〈 0.01）. The blood loss and fatality in group N3 were significantly higher than those in groups N1 and N2 （P 〈 0.01）. SOD of kidney in group N3 was significantly lower than that in group N1 and N2（ P 〈 0.01 ）. As the volume of fluid increased during resuscitation, Hct of all animals was gradually becoming lower. As MAPS in groups N2, N3 and N4 were gradually becoming lower and lower, death increased. Conclusions Limited fluid resuscitation （57 - 92 mL/kg） should be recommended to the therapeutic strategy for uncontrolled hemorrhagic shock.

关 键 词：休克 活动性出血 限制性补液 

分 类 号：R459.7[医药卫生—急诊医学]