急性高容血液稀释对严重烧伤家兔心肌损伤的影响  

Effect of acute hypervolemic hemodilution on myocardial damage in severely burned rabbits

作　　者：王惠枢[1] 张良成[1] 赖峻松[1] 范崇玖[1] 

机构地区：[1]福建医科大学附属协和医院麻醉科,福州市350001

出　　处：《中华麻醉学杂志》2015年第1期84-86,共3页Chinese Journal of Anesthesiology

基　　金：福建省卫生厅青年科研课题（2012-1-17）

摘　　要：目的 评价急性高容血液稀释（AHH）对严重烧伤家兔心肌损伤的影响.方法 健康成年家兔18只,体重2.0～ 2.5 kg,采用随机数字表法,将其分为3组（n=6）：对照组（C组）、烧伤组（B组）和AHH组.B组建立家兔40％体表面积Ⅲ度烧伤;AHH组建立烧伤模型后静脉输注6％羟乙基淀粉130/0.4行AHH,目标Hct为25％.于AHH前（T0）、AHH后2 h（T1）、4h（T2）和8 h（T3）时记录左心室收缩压（LVSP）、左心室舒张末压（LVEDP）、左心室内压最大上升速率（＋dp/dtmax）和左心室内压最大下降速率（-dp/dtmax）,同时抽取股静脉血样,采用ELISA法检测血清肌钙蛋白I（cTnI）的浓度.于T3时处死家兔,取心肌组织,光镜下观察病理学结果.结果 与C组比较,B组和AHH组T1-3时血清cTnI浓度和LVEDP升高,LVSP和＋dp/dtmax降低,B组T1-3时-dp/dtmax和AHH组T3时-dp/dtmax降低（P＜0.05）;与B组比较,AHH组T1-3时LVSP、＋dp/dtmax和-dp/dtmax升高（P＜0.05）,血清cTnI浓度和LVEDP差异无统计学意义（P＞0.05）,2组间病理学损伤程度无差异.结论 AHH不会加重严重烧伤家兔早期心肌损伤程度.Objective To evaluate the effect of acute hypervolemic hemodilution （AHH） on myocardial damage in severely burned rabbits.Methods Eighteen healthy adult rabbits,weighing 2.0-2.5 kg,were randomly divided into 3 groups （n =6 each） using a random number table：control group （group C）,burn group （B group） and AHH group.Rabbits were subjected to 3rd degree burn covering 40% of the total body surface area.After the model was established,6% hydroxyethyl starch 130/0.4 was infused intravenously,and the target Hct was 25% in AHH group.Before AHH （To） and at 2,4 and 8 h after AHH （T1-3）,left ventricular systolic pressure （LVSP）,left ventricular end-diastolic pressure （LVEDP）,＋dp/dtmax and-dp/dtmax were recorded,and blood samples from femoral veins were taken to determine the concentration of serum cardiac troponin I （cTnI） by ELISA.The rabbits were sacrificed at T3,and myocardial specimens were removed for microscopic examination of pathological changes with light microscope.Results Compared with group C,the serum cTnI concentration and LVEDP were significantly increased,LVSP and ＋dp/dtmaxwere decreased at T1-3 in B and AHH groups,and-dp/dtmax at T1-3 in group B and-dp/dtmax at T3 in group AHH were decreased.Compared with group B,LVSP,＋dp/dtmax and-dp/dtm,x were significantly increased at T1-3,and no significant change was found in serum cTnI concentration and LVEDP in group AHH.There was no significant difference in the pathological changes between group B and group AHH.Conclusion AHH can not aggravate the early myocardial damage in severely burned rabbits.

关 键 词：血液稀释 烧伤 心肌再灌注损伤 

分 类 号：R614[医药卫生—麻醉学]