超声多普勒评估小容量复苏时感染性休克大鼠心功能及腹主动脉血流的变化  

Influence of small volume resuscitation with different fluids on cardiac function and hemodynamics of abdominal aorta in septic shock rats

作　　者：罗晨芳[1] 刘德昭[1] 陈景晖 庞红宇[1] 黑子清[1] 

机构地区：[1]中山大学附属第三医院麻醉科,广东广州510630 [2]广州市妇女儿童医疗中心麻醉科

出　　处：《中国急救医学》2012年第10期919-923,I0001,共6页Chinese Journal of Critical Care Medicine

基　　金：广东省卫生厅基金项目（A2009197）;广东省科技计划项目（2011B031800058）

摘　　要：目的探讨不同液体早期小容量复苏对大鼠感染性休克引起的心功能和腹主动脉血流的影响。方法将清洁级SD大鼠30只根据复苏所用液体种类随机分为5组（每组n=6），正常组（N组）、内毒素休克组（LPS，E组）、7．5％高渗氯化钠组（LPS＋HSS，HSS组）、羟乙基沪粉液130／0．4（万汶）组（LPS＋HES，HES组）、高渗氯化钠羟乙基淀粉40溶液（霍姆）组（LPS＋HSH，HSH组）。各组在静注LPS（1mg／kg）30min后予小容量复苏（4mL／kg）干预。分别在LPS给药前、给药后30min及复苏后10、30、60min等5个时间点进行心脏、腹主动脉超声多普勒检测，记录血压、心率等变化。复苏60min处死大鼠，取心脏标本行病理学检查。结果①感染性休克大鼠心率明显增快（P〈0．01）．左室舒张末期内径（LVDd）明显缩小（P〈0．01），血压降低（P〈0．01），左室射』n1分数（LVEF）先是增强后明显减弱（P〈0．01），主动脉E／A值无明显改变；经三种液体分别复苏后，心率明显下降（P〈0．01），血压明显回升（P〈0．01），LVDd增大（P〈0．01），LVEF逐渐恢复，其中HSH组改善循环效果最明显。②感染性休克大鼠腹主动脉收缩峰值血流速度（Vmax）及舒张末期血流速度（Vmin）明显下降，阻力系数（RI）明显增大（P〈0．05）；复苏后Vmax及Vmin明显增大，RI下降（P〈0．05）。③5组的心脏石蜡切片HE染色未见明显病理性改变。结论不同液体早期小容量复苏对感染性休克大鼠心功能明显下降，腹主动脉血流减慢，阻力增大，小容量复苏能增加血容量，改善心功能；腹主动脉血流加快，阻力减小。HSH的复苏效果最好，其次是HES。Objective To investigate Influence of different fluids small - volume resuscitation on cardiac function and hemodynamics of abdominal aorta in septic shock rats. Methods 30 SD rats weighting 180- 250 g were divided randomly into 5 groups （n = 6 ） ： Group N （LPS negative control group）, Group E（ LPS ＋ 4 mL/kg physiologic saline）, Group HSS（ LPS ＋ 4 mL/kg Hypertonic saline solution）, Group HES （LPS ＋ 4 mL/kg Hydroxyethyl Starch ）, Group HSH （LPS ＋ 4 mL/kg Hypertonic Sodium Chloride Hydroxyethyl Starch）. Resuscitation were administrated 30 min after LPS injected. Doppler ultrasound examination of heart and abdominal aorta were measured at five time points： pre - injection of LPS, 30min post - injection of LPS, 1Omin post resuscitation, 30min post resuscitation , 60min post resuscitation. Then rats were executed and hearts were taken out. Heart pathological examination was observed under light microscope. Results （1）On the early stage of sepsis,septic septic shock rats＇heart systolic function increased first and then decreased obviously（ P 〈0.01 ）, LVDd decreased significantly, heart rate increased and blood pressure dereased, while these indexes were obviously recovered in resuscitation group, especially Group HSH; （2） septic shock rats＇abdominal aorta blood flow rate（BFR） became slower in systolic and diastolic phase, resistent index（RI） increased significantly（P 〈 0.01 ）. While BFR rised and RI descended in resuscitation group, especially Group HSH; （3） There were no significant pathological change between these five group. Conclusion Septic shock rats cardiac function depressed, blood volume decreased, the abdominal aorta BFR descended, RI increased. Small- volume resuscitation could improve cardiac function, increased blood volume and BFR, lowered RI. The use of HSH succeed to ameliorate the deleterious hemodynamic responses associated with endotoxemia in rat.

关 键 词：感染性休克 容量复苏 心脏 腹主动脉 超声多普勒 

分 类 号：R692.204[医药卫生—泌尿科学]