不同补液强度对重度失血性休克早期血清乳酸及钾的影响  

Impact of different rehydration intensity on serum lactate and potassium at the early stage of severe hemorrhagic shock

作　　者：杜鹏飞[1] 朱海彬[1] 赵会民[1] 

机构地区：[1]广西医科大学第一附属医院急诊科,广西南宁530002

出　　处：《中国急救医学》2013年第5期462-464,共3页Chinese Journal of Critical Care Medicine

基　　金：广西科学基金项目（桂科青0832040）

摘　　要：目的研究不同剂量液体治疗对重度失血性休克早期血清乳酸及钾的影响。方法采用控制性颈动脉放血法建立持续出血性休克兔模型，共42只，随机分为3组，各14只，无补液组不输液；大剂量复苏组按失血量两倍输液，速度参照平均动脉压70～80mmHg目标值调整；小剂量复苏组按失血量1倍输液，速度参照平均动脉压50-60mmHg目标值调整，于休克前及液体治疗1、2、3、4h分别检测血清乳酸及钾浓度，观察病死率。结果小剂量组血清乳酸及钾浓度在治疗1、2、3、4h均显著低于无补液组（P〈0．05）和大剂量复苏组（P〈0．05），4h病死率（1／14）显著低于无补液组（10／14），而大剂量组病死率（5／14）与其他两组比较差异无统计学意义。结论限制性液体复苏可以降低未控制失血的创伤出血性休克早期病死率，小剂量补液较快速大量补液更有利于抑制酸中毒进展及高钾血症。Objective To investigate the impact of different rehydration intensity on serum lactate and potassium at the early stage of severe hemorrhagic shock. Methods The rabbit models of progressive hemorrhagic shock were established by controlling the carotid artery bloodletting method, and forty - two male rabbits were randomly divided into 3 groups. Non - infusion group accepted nearly no fluid; massive - infusion group accepted fluid equal to times of the bleeding amount, adjusting speed according to mean arterial pressure （MAP） target 70 ~ 80 mm Hg; and limited -infusion group accepted fluid equal to the amount of bleeding, adjusting speed according to MAP target 50 ~ 60 mm Hg. The serum lactic acid and potassium level were detected respectively before and after shock, and at 1,2, 3, 4 h followed fluid resuscitation. The4 h -mortality was also discussed. Results There were 10, 5, 1 death within 4 h respectively in non - infusion group, massive - infusion group and limited - infusion group, the 4 h - mortality of limited - infusion group was significantly lower than that of non - infusion group（P = 0. 001 ）, but there were no significant differences between non - infusion group and massive - infusion group. The serum lactate and potassium were significantly lower in limited - infusion group than in other two groups （P 〈 0.05）. Conclusion Limited fluid resuscitation is more conducive to alleviating acidosis and hyperkalemia compared with massive infusion, which contributes to the decrease of early mortality in uncontrolled hemorrhagic traumatic shock.

关 键 词：创伤出血性休克 液体治疗 限制性液体复苏 乳酸 血钾 

分 类 号：R562.250.5[医药卫生—呼吸系统]