口服补液对致死性失血性休克犬血液动力学和微循环灌注的影响  

Effects of oral rehydration On hemodynamics and microcirculatory perfusion in dogs with fatal hemorrhagic shock

作　　者：胡森[1] 李琳[1] 侯经元[1] 王瑞晨[1] 

机构地区：[1]解放军总医院第一附属医院全军烧伤研究所休克与多器官障碍实验室,北京市100037

出　　处：《中华麻醉学杂志》2010年第4期448-451,共4页Chinese Journal of Anesthesiology

基　　金：军队十一五医学科研计划专项课题资助项目（06Z055）

摘　　要：目的 探讨口服补液对致死性失血性休克犬血液动力学和微循环灌注的影响.方法 成年雄性Beagle犬20只,按全身血容量的40%放血制作致死性失血性休克模型.随机分为3组：不补液组（NR组,n=8）、口服补液组（OR组,n=6）和静脉补液组（IR组,n=6）.失血后24 h内NR组无治疗,OR组和IR组于制模完成后即刻分别经胃管或静脉输入3倍失血量的葡萄糖-电解质溶液.失血后24 h开始各组动物均实施静脉补液,输入2倍失血量的乳酸钠林格氏液、葡萄糖盐水和复合氨基酸补充生理消耗量.于失血前（T0,基础状态）、失血后2h（T1）、4 h（T2）、8h（T3）、24 h（T4）、48 h（T5）和72 h（T6）时在非麻醉状态下测定MAP、全身血管阻力（SVR）、心指数（CI）、左心室内压最大变化速率（dp,dtmax）、及小肠粘膜血流量（IMBF）,并记录犬尿量及失血后72 h内死亡情况.结果 NR组、OR组和IR组病死率分别为63%、33%和0,3组间比较差异有统计学意义（P〈0.05）.与T0时比较,NR组T1-6时、OR组T1-5时、IR组T1-4时MAP、CI和dp/dtmax降低,3组失血后各时点SVR增高,IMBF降低（P〈0.05）,IR组和OR组T6时MAP、CI和dp/dtmax差异无统计学意义（P〉0.05）.与NR组比较,OR组和IR组MAP、CI、dp/dtmax 和IMBF升高,SVR降低,尿量增多（P〈0.05）;与IR组比较,OR组MAP、CI、dp/dtmax和IMBF降低,SVR升高,尿量降低（P〈0.05）.结论 大致死性失血性休克后24 h内口服3倍失血量的葡萄糖-电解质溶液能显著改善血液动力学和机体微循环灌注,从而改善机体的生存状态,具有显著的复苏效果.Objective To investigate the effect of oral rehydration on hemedynamies and mierocirculatory perfusion in dogs with fatal hemorrhagic shock.Methods Twenty male Beagle dogs 16-20 months old weighing 8-12 ks were subjected to a loss of 40% of the total blood volume,then divided into 3 groups：no rehydration group （group NR,n=8）,oral rehydration group（group OR,n=6）and intravenous rehydration group（group IR,n=6）.Group NR received no treatment within 24 h after blood-letting.Group IR and OR were given glucose-electrolyte solution （GES） either by gastric tube or by intravenous infusion 3 times volume of the blood loss immediately after the establishment of the model.Then the lactated Ringer＇s solution,glucose saline and compound amino acid（2 times volume of the blood loss）were started to be given to supplement the physiological consumption from 24 h after blood-letting in each group.The MAP,cardiac index（CI）,systemic vascular resistance （SVR）,dp/dtmax,and intestinal mucoflal blood flow （IMBF） were determined before blood-letting（T0,baseline） and 2 h （T1）,4 h（T2）,8 h（T3）,24 h（T4）,48 h（T5） and 72 h（T6）after blood-letting.The fatality rate within 72 h after blood-letting and urinary output were calculated.Results The fatality rates were 63%,33%and O in group NR, OR and IR respectively, which showed significant difference between the groups （P 〈 0.05）.Compared with the baseline values at To, MAP, CI and dp/dtmax were significantly decreased at T1-6, in group NR,at T1-5 in group OR and at T1-4 in group IR, and SVR was significantly increased, while IMBF decreased at each time point after blood-letting in the three groups （ P 〈0.05）, but no significant change was found in MAP, CI and dp/dtmax at T6 in group IR and OR （P〉0.05）. MAP, CI, dp/dtmax , IMBF and urinary output were significantly higher, while SVR was significantly lower in group OR and IR than in group NR （ P 〈 0.05）. MAP, CI,dp/dtmax, IMBF and urinary output were signiflcandy lo

关 键 词：休克 出血性 补液疗法 血流动力学 微循环 

分 类 号：R459.7[医药卫生—急诊医学]