口服补液对失血性休克犬肺组织含水量和血管通透性的影响  

Oral fluid resuscitation on pulmonary vascular permeability and lung water content in dog with hemorrhagic shock

作　　者：胡森[1] 李琳[1] 侯经元[1] 王瑞晨[1] 

机构地区：[1]中国人民解放军总医院第一附属医院烧伤研究所休克与多器官障碍实验室,北京100048

出　　处：《中国急救复苏与灾害医学杂志》2010年第9期819-821,838,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：全军医学科研“十一五”专项课题（06Z055）

摘　　要：目的研究口服补液对失血性休克犬肺组织含水量和血管通透性的影响。方法成年Beagle犬20只，先期无菌手术行颈动、静脉置管，24h后按全身血容量的40％放血制作失血性休克模型。随机分为不补液组（n=8）、口服补液组（n=6）和静脉补液组（n=6）。失血后第1个24hTF补液组无治疗，口服补液组和静脉补液组分别从胃内或静脉输入3倍失血量的葡萄糖一电解质溶液。失血后24h起3组均给予静脉补液。于失血前和失血后第2、4、8、24、48和72小时测定动物非麻醉状态下的平均动脉压（MAP）、动脉氧分压（PaO2）、血管外肺水指数（ELWI）和肺血管通透性指数（PVPI），于失血后72h或濒死前处死动物，测定肺组织含水率。结果不补液组失血后72h死亡率为5／8（62．5％），口服补液组为2／6（33．3％），静脉补液组为0。不补液组ELWI和PVP失血后8h分别比失血前增加31．4％和78．8％，PaO2降低22．4％。口服补液组失血后8h ELWI[（148．4±10．3）m1]和PVPI（4．7±0．4）显著低于不补液组[（168．8±12．1）ml]和[（5．9±0．6）ml，P〈0．05]，但高于静脉补液组[（132．1±8．0）ml和（4．7±0．5）ml，均P〈0．05]。口服补液组PaO2[（102．5±3．0）mmHg],显著高于不补液组[（86．3±2．9）mmHg，P〈0．05）]，与静脉补液组[（99．9±3．2）mmHg]无显著差别。肺组织含水率在口服补液组与静脉补液组之间无统计学差别[（78．3±1．19）％vs．（76．8±0．91）％，P〉0．05）]，但均显著低于不补液组[（80．6±0．68）％，P〈0．05]。结论早期口服补液对肺的保护作用虽然不如静脉补液，但与不补液组相比，能显著改善失血性休克期肺血管通透性和肺水肿，减轻肺脏并发症。Objective To investigate the effect of oral fluid resuscitation on pulmonary vascular permeability and lung water content in dog with hemorrhagic shock. Methods 20 Beagle dogs subjected to hemorrhagic shock with about 40% of total blood volume loss were divided into three groups - no resuscitation group of eight （NR）, oral resuscitation group of six （OR）, and intravenous resuscitation group of six （VR）. In the first 24 hours after hemorrhage, the OR and VR groups were given resuscitation with glucose-electrolyte solution （GES） of three times of blood loss by gastric and intravenous infusion respectively, while NR group given nothing. In the second 24 hours, all three groups received delayed intravenous fluid resuscitation. MAP, PaO2, ELWI and PVPI were determined before and at 2, 4, 8, 24, 48 and 72 hours after bleeding. At end of the 72-hour experiment, animals were sacrificed for evaluation of lung water content. Results Over the 72 hours, five out of eight, 62.5%, died in NR group, two out of six, 33.3%, died in OR group, and no animal died in VR group. ELWI and PVPI of OR group were significantly lower than those of NR group, yet higher than those of VR group （all P〈 0.05）. PaO2 of OR group was considerably higher than that of NR group （P〈 0.05）, yet showed no significant difference from that of VR group （P〉 0.05）. Lung water content of two fluid resuscitation groups reflected no much difference （78.3±1.19）% vs. （76.8±0.91）%, （ P〉 0.05）, but all obviously lower than that of NR group （80.6±0.68）%, （P〈 0.05）. Conclusion Although oral resuscitation with GES does not function as efficient as IV, it helps improve from pulmonary vascular permeability, alleviate lung edema, reduce the pulmonary complication, and mortality, comparing with the group without any resuscitation given.

关 键 词：失血性休克 液体治疗 血管通透性 肺水肿 

分 类 号：R654.1[医药卫生—外科学]