限制性液体复苏对未控制失血休克的早期效果及机制  

Therapeutic effect and mechanism of limited fluid resuscitation during the early stage of uncontrolled hemorrhagic traumatic shock

作　　者：赵会民[1] 杜鹏飞[1] 朱海彬[1] 

机构地区：[1]广西医科大学第一附属医院急诊科,1广西南宁530002

出　　处：《中国急救医学》2014年第3期247-250,共4页Chinese Journal of Critical Care Medicine

基　　金：广西自然科学基金项目（桂科青0832040）

摘　　要：目的研究限制性液体复苏对未控制失血的创伤出血性休克的早期治疗效果及机制。方法采用控制性颈动脉排血法建立持续出血性休克兔模型，随机分为3组，各14只，建立颈外静脉补液通道，复苏液体为0．9％氯化钠溶液与羟乙基淀粉40氯化钠溶液混合液（体积比2：1）；无补液组不输液；大剂量复苏组按失血量2．5倍输液，速度参照平均动脉压（MAP）目标值70-80mmHg调整；小剂量复苏组按失血量1倍输液，输液速度参照MAP目标值50—60mmHg调整，于休克前后及补液治疗1、2、2、3、4h分别检测MAP、红细胞计数（RBC）、血清乳酸浓度、血清肌酸激酶同工酶MB（CK—MB）等指标，比较休克4h病死率及尸检病理情况。结果①无补液组、大剂量组、小剂量组4h病死率分别为71％（10／14）、36％（5／14）、7％（1／14），小剂量组显著低于无补液组（P=0．001），大剂量组与无补液组比较差异无统计学意义。②小剂量组各治疗时间点的MAP、血清乳酸浓度均显著低于无补液组（P〈0．01）和大剂量复苏组（P〈0．01），而CK—MB浓度显著低于无补液组（P〈0．05），RBC显著高于无补液组（P〈0．01），但与大剂量复苏组比较差异无统计学意义。③病理结果显示，小剂量组存活动物心肺病理损伤程度较轻。结论对失血未控制的创伤出血性休克进行限制性液体复苏可以降低休克早期病死率，机制与小剂量液体复苏相对于快速大量补液能够更长时间维持较低水平MAP、更有利于缓解组织无氧代谢、抑制心肺损伤和促进红细胞动员有关。Objective To investigate the therapeutic effect and mechanism of limited fluid resuscitation during the early stage of uncontrolled hemorrhagic traumatic shock. Methods The uncontrolled hemorrhagic traumatic shock rabbit model was established by controlling the carotid artery bloodletting. Forty - two male rabbits were randomly divided into 3 groups （n = 14 ） that received different fluid management. The mixed liquid composed of 0. 9% sodium chloride solution and hydroxyethyl starch （40） sodium chloride at a volume ratio 2：1 was used for infusion by channel established in external jugular vein. Non - infusion group accepted nearly no fluid, massive - infusion group accepted fluid amount equal to 2.5 times of the bleeding amount, adjusting speed reference to MAP target 70 ~ 80 mmHg, and limited - infusion group accepted fluid amount equal to the amount of bleeding, adjusting speed reference to mean arterial pressure （MAP） target 50 ~ 60 mm Hg. The red blood cell count, serum creatine kinase isozyme MB （ CK - MB） , and serum lactic acid concentration were detected before and after shock, and in 1,2, 3,4 h after fluid resuscitation. The 4 h mortality and cardiopulmonary pathological manifestations were discussed. Results While no significant difference in 4 h mortality between massive- infusion group （5/14） and non- infusion group （10/14）, limited - infusion group showed significantly lower mortality （ 1/14 ） than non - infusion group （ P = 0. 001 ）. MAP and blood lactate concentration were significantly lowered in limited - infusion group comparing with non - infusion group （ P 〈 0.01 ） and massive - infusion group （ P 〈 0.01 ）. A significantly lower CK - MB concentration（ P 〈 0.05 ） and a higher RBC （ P 〈 0.01 ） were shown in limited - infusion group comparing with non - infusion group but without significant difference with massive - infusion group. A milder cardiopulmonary pathological damage was also shown in limited - infusion group comparing with other

关 键 词：创伤出血性休克 液体治疗 病理进程 乳酸 平均动脉压(MAP) 肌酸激酶同工酶(CK—MB) 

分 类 号：R605.971[医药卫生—急诊医学]