失血性休克兔复苏的多因素分析  

Analysis of multiple factors in the resuscitation of hemorrhagic shock in rabbits

作　　者：李洪波[1] 周华成[1] 刘金锋[1] 

机构地区：[1]哈尔滨医科大学附属第二医院麻醉科,150086

出　　处：《中华麻醉学杂志》2009年第12期1116-1119,共4页Chinese Journal of Anesthesiology

基　　金：黑龙江省攻关课题（GC04C3042）

摘　　要：目的评价两种高渗液体、两种液体温度和两种复苏目标血压对失血性休克兔的复苏效果，寻找合理的复苏方案。方法采用随机分组三因素两水平析因设计，实验因素为高渗液体种类（因素A）、液体温度（因素B）和复苏目标血压（因素C），A1和A2分别为7．5％NaCl（HS）和7．2％NaCl＋6％右旋糖酐40混合液（HSD），B1和B2分别为常温（23℃）和高温（45℃），C1和C2分别为平均动脉压（MAP）60mmHg和MAP80mmHg。按各因素不同水平排列组合，40只成年雄性家兔随机分为8组（n=5）：A1B1C1组、A1B1C2组、A1B2C1组、A1B2C2组、A2B1C1组、A2B1C2组、A2B2C1组和A2B2C2组。采用Wiggers改良法建立失血性休克模型，模型建立成功后立即进行液体复苏，分别在建立模型前（基础状态）、失血性休克模型建立成功时、液体复苏1、2、3h时采集动脉血样，进行血气分析，测定全血乳酸浓度、血清肿瘤坏死因子α（TNF-α）和白细胞介素6（IL-6）浓度，监测小肠系膜微循环和直肠温度。结果行HSD复苏动物的动脉血二氧化碳分压（PaO2）高于行HS复苏的动物，行常温HSD复苏动物的PaO2高于行常温HS复苏的动物（P〈0．05）；行常温HSD复苏动物的全血乳酸浓度低于行常温HS复苏的动物（P〈0．05）；行HSD复苏动物的血清TNF—α和IL-6浓度低于行HS复苏的动物（P〈0．05）。行常温液体复苏动物的血清TNF—α浓度低于行高温液体复苏的动物（P〈0．05）；因素C对上述各指标的影响均无统计学意义（P〉0．05），与各因素间无交互作用。各因素对小肠系膜微循环的影响无统计学意义（P〉0．05）。行高温液体复苏动物的直肠温度下降速度明显减慢（P〈0．05）。结论失血性休克兔HSD的复苏效果优于HS，常温液体的复苏效果优于高温液体，液体种类与液体温度间存在交互作用，虽然两种复苏目标血压对复苏效果�Objective To investigate the effects of two different resuscitation fluids of two different temperatures and two different target MAP on the outcome of hemorrhagic shock in rabbits. Methods Forty adult male rabbits weighing 2.3-3.2 kg were anesthetized with iv pentobarbital sodium 30-35 mg/kg and tracheostomized. Spontaneous breathing was maintained. Hemorrhagic shock was induced according to modified Wiggers method. Two different resuscitation fluids 7.5% NaCl （HS） （A1 ） and 7.2% NaCl ＋ 6% dextran 40 （HSD） （A2 ） were used. The temperature of the fluids was 23℃ （B1） and 45℃ （B2） respectively. The target MAP was 60 mm Hg （C1） and 80 mm Hg （C2）. Forty animals were randomly divided into 8 groups （n = 5 each）： group A1 B1 C1; group A1 B1 C2 ; group A1 B2 C1 ; group A1 B2 C2 ; group A2 B1 C1 ; group A2 B1 C2 ; group A2 B2 C1 and group A2 B2 C2 . Arterial blood samples were obtained from femoral artery at 5 min before blood-withdrawal, immediately after shock was induced and at 1, 2, and 3 h of resuscitation for blood gas analysis and determination of blood lactate concentration and serum concentrations of TNF-α and IL-6. Hemodynamics and changes in mesenteric capillaries were continuously monitored. Results PaO2 was significantly higher in animals resuscitated with HSD （A1） than in animals resuscitated with HS （ A2 ）. Blood lactate concentration was significantly higher in group A1B1 （HS-23℃） than in group A2B1 （HSD-23℃）. There was no significant difference in blood lactate concentration between group A1B2 （ HS-45 ℃ ） and group A2 B2 （ HSD-45 ℃ ）. The 3 factors did not have different effects on mesenteric capillaries. The serum TNF-α and IL-6 concentrations were significantly higher in animals resuscitated with HS （ A1 ） than in animals resuscitated with HSD （A2 ）. Conclusion The effect of resuscitation of hemorrhagic shock is better with HSD than with HS. The resuscitation fluid of 23 ℃ is superior to fluid of higher temperature.

关 键 词：休克 出血性 补液疗法 氯化钠 右旋糖酐类 温度 血压 

分 类 号：R459.7[医药卫生—急诊医学]