高容量血液滤过对早期感染性休克猪复苏液体量和血管活性药物用量的影响  

The effect of high volume hemofiltration on fluid resuscitation and the dosage of vascular active drug in early septic shock pigs

作　　者：张敏[1] 赵平[1] 薛露[1] 吴晓燕[1] 郑瑞强[1] 

机构地区：[1]扬州大学医学院附属临床医院江苏省苏北人民医院重症医学科,江苏扬州225001

出　　处：《中国急救医学》2014年第11期977-981,共5页Chinese Journal of Critical Care Medicine

基　　金：江苏省“333高层次人才培养工程”基金（2011-15）

摘　　要：目的了解高容量血液滤过（HVHF）对感染性休克早期液体复苏所需液体量和维持血压所需血管活性药物用量的影响。方法给予18只健康猪静脉输注内毒素50μg/kg诱导感染性休克模型，制模成功后随机分为三组（每组6头）：对照组、常规流量血液滤过组（NVHF组）和HVHF组，均给予机械通气。感染性休克模型建立后每组均应用乳酸林格液液体复苏，以每搏输出量变异率（SVV）＜10％作为液体复苏终止指标，之后静脉输注乳酸林格液保持SVV＜10％，如平均动脉压（MAP）仍未达到基础值的90％以上，予持续静脉泵入去甲肾上腺素维持MAP在基础值90％以上，记录实验开始后基础、成模及治疗1、2、3、4、5、6h血流动力学指标和治疗期间维持SVV＜10％，以及MAP达到基础值90％以上各组乳酸林格液用量和去甲肾上腺素用量。结果与对照组比较，HVHF组在开始治疗1h后维持SVV＜10％所需乳酸林格液用量明显减少（P＜0.05），NVHF组在1、3、4h维持SVV＜10％所需乳酸林格液用量较对照组明显减少（P＜0.05）；与NVHF组比较，血液滤过治疗2h后，HVHF组维持SVV＜10％所需乳酸林格液用量明显减少（P＜0．05）；与对照组和NVHF组比较，血液滤过治疗4h后，HVHF组维持MAP所需去甲肾上腺素用量明显减少（P＜0．05），而NVHF组与对照组比较差异无统计学意义。结论早期应用HVHF治疗感染性休克能够明显减少猪复苏液体量和去甲肾上腺素用量。Objective To explore the high volume hemofiltration （HVHF ） on fluid resuscitation and the dosage of vascular active drug in early septic shock .Mtehods Eighteen healthy pigs were injected endotoxin 50μg/kg via central vein within 30 minutes.After model establishment, all pigs were randomly divided into three groups （ n =6）： control group, normal volume hemofiltration （ NVHF） group and high volume hemofiltration （ HVHF ） group.All the three groups were given mechanical ventilation.Lactic acid salinger liquid for fluid resuscitation was provided after septic shock model establishment, with stroke volume variation （ SVV） less than 10%as an index of liquid recovery termination;SVV would be kept lower than 10% by using intravenous infusion lactic acid salinger liquid.Continuous intravenous infusion of norepinephrine was used to maintain MAP on the basis of the value of more than 90%.Hemodynamic indexes were recorded before infusion endotoxin, 0 h after shock model establishment and 1, 2, 3, 4, 5, 6 h after they were given hemofiltration treatment;the quantity of fluid resuscitation and the dose of norepinephrine during the treatment were tracked.Results＆amp;nbsp;Compared with control group, after 1 hour＇s hemofiltration treatment, the quantity of lactic acid salinger liquid in HVHF group was significantly lower （P〈0.05）.The NVHF group in 1, 3, 4 hours, the quantity of lactic acid salinger liquid to maintain SVV〈10%, was significantly decreased than that of the control group （P〈0.05）.After 2 hours＆#39;hemofiltration treatment, the dosage of lactic acid salinger liquid in HVHF group was significantly lower than NVHF group （ P 〈0.05 ）.After 4 hours hemofiltration treatment, the dose of norepinephrine to sustain the MAP in HVHF group was obviously lower than those in NVHF group and control group, while NVHF group compared with control group has no significant statistical difference.Conclusion The application of HVHF in early septic shock can significantly reduce the quanti

关 键 词：高容量血液滤过( HVHF) 感染性休克 液体复苏 每搏输出量变异率(SVV) 

分 类 号：R459.5[医药卫生—治疗学]