不同复苏方法用于重度非控制性失血性休克犬早期复苏效果的比较  

Comparison of different resuscitation strategies during early stage in a dog model of severe uncontrolled hemorrhagic shock

作　　者：江山[1] 车邦民[1] 何绍明[1] 

机构地区：[1]解放军第四五四医院麻醉科,南京市210002

出　　处：《中华麻醉学杂志》2013年第6期733-738,共6页Chinese Journal of Anesthesiology

基　　金：南京军区医学科技创新课题（08Z014）

摘　　要：目的比较垂体后叶素复苏、高渗盐水复苏和胶体液复苏用于重度非控制性失血性休克（UHS）犬的早期复苏效果。方法成年中华田园犬，雌雄不拘，体重10～12k，采用肠系膜动脉分支切断＋股动脉穿刺放血法制备重度UHS模型。取重度UHS犬24只，采用随机数字表法，将其分为3组（n=8）：血管加压素复苏组（P组）：静脉注射垂体后叶素负荷量0．1U，继之以0．04U·kg^-1·min^-1的速率静脉输注，间断追加0．1U；高渗盐水复苏组（SA组）：单次注射静脉输注7．5％高渗氯化钠注射液6ml／kg；胶体液复苏组（HES组）：静脉输注200／0．5羟乙基淀粉溶液，输注速率18～38ml．kg^-1·h^-1，各组均维持MAP不低于50mmHg。各组复苏1h后结扎肠系膜动脉分支彻底止血，充分容量复苏。1h后结扎止血行充分容量复苏。于模型制备前（R）、模型制备成功即刻（T1）、复苏15min（T2）、30min（B）、45min（T4）、60min（T5）以及结扎肠系膜动脉并充分容量复苏2h（B）时记录血流动力学指标；T0、T1、T5和T6时取动脉血样，行血气分析；T0、T5、T6及拔除导管后3d采集静脉血样，采用双抗体夹心ABC—ELISA法，测定血清TNF-α、IL-10及促肾上腺皮质醇激素（AcTH）的浓度，计算TNF-α／IL-10比值。记录结扎肠系膜动脉并充分容量复苏后72h内动物的生存情况。记录UHS模型制备期间（急性创伤失血期）和非控制性出血复苏期的出血量。结果与P组比较，SA组SBP、DBP、CVP、HR升高，Hct降低，血清IL-10浓度降低，TNF-α浓度、TNF-α/IL-10比值升高，HES组SBP、HR和Lac升高，血清IL-10浓度降低，TNF—α和ACTH浓度、TNF-α／IL-10比值升高（P〈0．05或0．01）；与SA组比较，HES组SBP、DBP、CVP、HR降低，Lac升高，血清IL-10浓度降低，TNF—α和ACTH浓度、TNF—α／IL．10比值升高（P〈0．05）。sA组非控制性失血期失血量明显多于P组和HESObjective To compare pituitrin resuscitation, hypertonic saline resuscitation versus hydroxy- ethyl starch （HES） resuscitation during the early stage in a dog model of severe uncontrolled hemorrhagic shock （UHS）. Methods Adult Chinese rural dogs of both sexes, weighing 10-12 kg, underwent sever UHS by transect- ing one branch of mesenteric arteries, followed by blood withdrawal via the femoral artery to target mean arterial pressure （MAP） of 50 mm Hg. Twenty-four dogs with severe UHS were randomized into 3 groups according to re- suscitation strategies （n = 8 each）： pituitrin resuscitation group （group P）, hypertonic saline resuscitation group （group SA）, and resuscitation with HES （group HES）. In group P, pituitrin was infused at a rate of 0.04 U·g^1·min^-1 after a loading dose of 0.1 U was given intermittently. A single bolus of 7.5 % hypertonic saline 6 ml/kg was injected in group SA. HES 200/0.5 was infused at a rate of 18-38 ml·kg-1·h-1 in group HES. MAP was maintained no lower than 50 mm Hg in each group. The branch of mesenteric arteries was ligated 1 h after re- suscitation and all the blood initially shed was returned in each group. The parameters of hemodynamics were recorded before UHS （T0 ）, after successful UHS （T1）, at 15, 30, 45 and 60 rain of resuscitation （T2-5 ）, and at 2 h after hemostasis and return of shed blood （T6） .Arterial blood samples were taken at To, T1 , T5 and T6 for blood gas analysis. Venous blood samples were collected at T0, T5, T6 and 3 days after extubation for determination of serum TNF-α, IL-10 and adrenocorticotropic hormone （ACTH） concentrations. TNF-α/IL-10 ratio was calculated. The survival rate was measured within 72 h after hemostasis and return of shed blood. The volume of blood loss was recorded during UHS phase and uncontrolled bleeding resuscitation phase. Results Compared with group P, SBP, DBP, CVP, HR, serum TNF-α concentration and TNF-a/IL-10 ratio were significantly increased, and Hct and serum IL-10 con

关 键 词：休克 出血性 垂体激素类 后叶 盐水 高渗 羟乙基淀粉 补液疗法 

分 类 号：R459.7[医药卫生—急诊医学]