创伤早期未控制性出血非手术疗法的实验研究  

Experimental study on resuscitation from uncontrolled hemorrhagic shock during early period of trauma

作　　者：雷黎明[1] 张干[2] 何绍明[2] 

机构地区：[1]南京医科大学附属南京妇幼保健院麻醉科,江苏南京210004 [2]解放军第454医院麻醉科,江苏南京210002

出　　处：《临床军医杂志》2013年第12期1211-1213,共3页Clinical Journal of Medical Officers

基　　金：南京军区医学科技创新课题(08Z014)

摘　　要：目的探讨延迟复苏、低容量液体复苏、脑垂体后叶素复苏对创伤早期重度未控制性失血性休克(UHS)复苏效果的影响。方法成年健康中华田园犬24只,股动脉放血,制作重度UHS模型。采用完全随机法随机分为A组(延迟复苏组);B组(低容量液体复苏组);C组(脑垂体后叶素组)。观察各组放血前即刻(T0)、达到目标血压时(T1)、实施三种复苏方法后1 h(T2)、复苏平稳后2 h(T3)各时点的HR、MAP、CVP、血气分析及各组的出血量和72 h存活率。结果 T2时点,A组的CVP、MAP明显低于B组和C组(P<0.05),B组和C组间差异无统计学意义(P>0.05)。B组和C组在T3时点的血流动力学指标接近T0;在T2时点,A组的PaO_2明显低于B组和C组(P<0.05),A组中心静脉血乳酸(BL)和碱剩余(BE)均明显高于B组和C组(P<0.05),B组BE明显高于C组(P<0.05)。T3时点,B组和C组的BL和BE均组和明显高于T0时点(P<0.01),低于T1时点(P<0.01)。三组间的Hct、出血量比较差异无统计学意义(P>0.05);A组72 h内存活率明显低于B组和C组(P<0.01)。结论低容量液体复苏能显著提高重度UHS时的存活率;小剂量垂体后叶素的复苏效果优于低容量液体复苏。Objective To study the effects of delayed resuscitation, limited fluid resuscitation and pituitrin resuscitation on uncon- trolled hemorrhagic shock during early period of trauma. Methods Uncontrolled hemorrhagic shock was produced by exsanguina- tion from arteria cruralis in 24 healthy clogs which were then randomized into three groups （ n = 8/group） , i.e. Group A （ delayed resuscitation）, Group B （limited fluid resuscitation）, Group C （pituitrin resuscitation）. Heart rate （HR）, mean artery pressure （MAP） and central venous pressure （CVP） , as well as blood gas analysis, were monitored at the time point of TO （before exsan- guination） , T1 （ goal blood pressure achieved） , T2 （ 1 hour after T1 ） and T3 （ 2 hours after T2）. Blood loss and survival after 72 hours were observed. Results At T2,CVP and MAP in Group A were significantly lower than that in Group B and in Group C （P 〈0.05）. At T3, the hemodynamic indexes in Group B and Group C were close to that at TO. At T2, PaO2 in Group A was significantly lower than that in Group B and Group C （P 〈 0.05）. BL and base excess （BE） in Group A were significantly higher than that in Group B and Group C （P 〈 0.05）. BE in Group B was significantly higher than that in Group C （P 〈 0.05 ）. At T3, BL and BE in Group B and Group C were significantly higher than that at TO （ P 〈 0.01 ） , but significantly lower than that at T1 （ P 〈 0.01 ）. Among the three groups there were no significant differences in hematocrit （Hct） and blood loss （P 〉0.05）. Survival in Group A was significantly lower than that in Group B and Group C （ P 〈 0.01 ）. Conclusion In serious uncontrolled hemorrhagic shock, limited fluid resuscitation significantly improves survival. Pituitrin is more effective than limited fluid in serious uncontrolled hemor- rhagic shock.

关 键 词：失血性休克 未控制性 延迟复苏 低容量液体 脑垂体后叶素 

分 类 号：R605.971[医药卫生—急诊医学]