环境低温对失血性休克猪血流动力学及氧动力学的影响  

Effects of low ambient temperature on hemodynamics and oxygen dynamics in a porcine hemorrhagic shock model

作　　者：张雪峰[1] 张成[1] 高广荣[1] 蒋会勇[1] 吕晨光[1] 张宝磊[1] 谢名双[1] 张智丽[1] 余筣 

机构地区：[1]沈阳军区总医院普通外科,沈阳110016

出　　处：《解放军医学杂志》2013年第2期94-98,共5页Medical Journal of Chinese People's Liberation Army

基　　金：全军“十一五”医药卫生科研基金(08G002)~~

摘　　要：目的探讨环境低温对失血性休克猪血流动力学及氧动力学的影响。方法健康成年巴马香猪32只,随机分为正常对照组、室温(22℃)休克组、低温(-10℃)休克组和保温休克组(室温下观察,并维持肺动脉温度为38.5～39.5℃),每组8只。休克组动物放血(40%血容量)建立失血性休克模型,记录建模前(0min)至建模后4h内不同时间点实验猪的核心体温(肺动脉温度、直肠温度)、心率(HR)、平均动脉压(MAP)、肺动脉压(PAP)、肺动脉楔压(PAWP)、中心静脉压(CVP)、心输出量(CO)、血红蛋白(Hb)、混合静脉血氧饱和度(SvO2)及动脉血气分析结果,计算氧摄取率(O2ER)、氧供指数(DO2I)和氧耗指数(VO2I)。结果保温休克组实验期间共有4只动物死亡,其余3组动物均存活(P<0.05)。与保温休克组比较,正常对照组、室温休克组、低温休克组核心体温明显下降(P<0.05),从休克后120min开始低温休克组核心体温下降更明显,与室温休克组和正常对照组比较差异有统计学意义(P<0.05)。室温休克组和低温休克组在血流动力学、氧动力学及预后方面未表现出明显差异;保温休克组的心率及氧耗指数明显高于低温休克组和室温休克组(P<0.05),其余指标与后两组比较差异无统计学意义(P>0.05)。结论低温环境下失血性休克猪的血流动力学和氧动力学指标并未出现恶化趋势,麻醉引起的诱导性低温可能是导致这种现象的原因。To investigate the effects of low ambient temperature on hemodynamics and oxygen dynamics in a porcine hemorrhagic shock model. Methods Thirty-two healthy adult Bama miniature pigs were randomly divided into four groups （8 each）： control （group C）, shock under room temperature （22℃, group R）, shock under low ambient temperature （-10℃, group L） and shock under normal body temperature （keep pulmonary arterial temperature ranged from 38.5 to 39.5 ℃, group N）. The hemorrhagic shock model was reproduced by venous bleeding （40% of total blood volume）, and the core temperature （pulmonary arterial temperature and rectal temperature）, heart rate （HR）, mean arterial pressure （MAP）, pulmonary arterial pressure （PAP）, pulmonary arterial wedge pressure （PAWP）, central venous pressure （CVP）, cardiac output （CO）, hemoglobin （Hb）, saturation of mixed venous blood （SvO2） and blood gas analysis were recorded before reproduction of shock and at different time points after hemorrhagic shock. The whole body oxygen delivery index （DO2I）, oxygen uptake index （VOzI）, and oxygen extraction ratio （O2ER） were calculated. Results Four pigs died in group N during the experiment, meanwhile, no pig died in other groups. The core temperature in group C, R and L decreased significantly compared with group N （P〈0.05）, and the core temperature in group L was significantly lower than that in groups C and R from 120 minutes after shock. No difference was found in hemodynamics, oxygen dynamics and prognosis between group R and group L. The HR and VO2I in group N were significantly higher than those in group L and group R, while there was no difference in other indices between the 3 groups. Conclusion The hemodynamics and oxygen dynamics indices don＇t worsen in hemorrhagic shock pigs under low ambient temperaturej possibly resulting from induced hypothermia caused by anesthesia.

关 键 词：休克 出血性 温度 血液动力学现象 血气分析 

分 类 号：R605.971[医药卫生—急诊医学]