舌下微循环变化在猪失血严重程度评估中的应用价值  

Value of sublingual microcirculation on hemorrhage severity in the pig

作　　者：黄增[1] 徐杰丰[1] 陈国锋[1] 徐洪铭 方雅[1] 屠海霞[1] 李子龙[1] Huang Zeng Xu Jiefeng Chen Guofeng Xu Hongming Fang Ya Tu Haixia Li Zilong(Department of Emergency Medicine, Yuyao People ＇s Hospital, Medical School of Ningbo University, Yuyao 315400, China)

机构地区：[1]宁波大学医学院附属余姚市人民医院急诊科,浙江余姚315400

出　　处：《中华危重症医学杂志（电子版）》2016年第5期328-333,共6页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：浙江省医药卫生科技计划项目(2013KYA191)

摘　　要：目的探讨舌下微循环变化在猪失血严重程度评估中的应用价值。方法健康雄性白猪20只,实验猪的总血容量被评估为70 ml/kg,根据失血比例的不同分为4组:对照组、25%失血组、35%失血组和45%失血组,每组5只。比较各组动物失血前体质量、心率、平均动脉压、心输出量、血乳酸及微血管流动指数(MFI)和灌注血管密度(PVD)变化,并分别于失血后30 min、1 h、2 h、3 h、4 h,评估动物的平均动脉压、心输出量、血乳酸、MFI及PVD的变化。结果各组动物失血前体质量、心率、平均动脉压、心输出量、血乳酸、MFI及PVD比较,差异均无统计学意义(F=0.156、0.260、0.467、0.417、0.434、1.778、0.149,P均>0.05)。随着各组动物失血量的增加,平均动脉压及心输出量于失血后30 min[(117±8)、(56±10)、(45±4)、(31±5)mm Hg,(4.80±0.54)、(3.32±0.32)、(2.35±0.37)、(1.67±0.15)L/min]及失血后1 h[(123±4)、(89±6)、(67±8)、(52±8)mm Hg,(4.79±0.63)、(3.99±0.37)、(2.75±0.35)、(2.05±0.39)L/min]逐渐下降(P均<0.05),血乳酸于失血后1 h逐渐增加[(1.12±0.33)、(2.10±0.25)、(3.74±1.38)、(5.88±1.48)mmol/L,P均<0.05],MFI[(2.92±0.09)、(2.47±0.28)、(1.30±0.14)、(0.87±0.27),P均<0.05]及PVD水平[(4.95±0.12)、(4.20±0.54)、(2.98±0.10)、(2.64±0.31),P均<0.05]于失血后30 min逐渐下降。Pearson相关性分析显示MFI及PVD与平均动脉压(r=0.903、0.923,P均<0.05)、心输出量(r=0.919、0.919,P均<0.05)呈显著正相关,与乳酸水平呈显著负相关(r=-0.706、-0.745,P均<0.05)。结论舌下微循环监测可实时反映机体失血程度,有助于判断失血严重程度。Objective To investigate the value of sublingual microcirculation on hemorrhage severity in the pig. Methods Twenty healthy male pigs were randomized into four groups according to the percentage of blood loss volume（the total blood volume was assessed for 70 ml / kg）：sham group, 25% blood loss group, 35% blood loss group and 45% blood loss group, 5 pigs in each group. The levels of mean arterial pressure, cardiac output, blood lactic acid,microvascular flow index（MFI） and perfused vessel density（PVD） were regularly evaluated on30 min, 1 h, 2 h, 3 h, and 4 h after hemorrhage. The body mass, heart rate, mean arterial pressure, cardiac output, blood lactic acid, MFI and PVD before hemorrhage were compared.Results The body mass, heart rate, mean arterial pressure, cardiac output, blood lactic acid,MFI and PVD before hemorrhage all showed no significant differences among four groups（ F =0.156, 0.260, 0.467, 0.417, 0.434, 1.778, 0.149; all P〈0.05）. When the volume of blood loss was gradually increased, the mean arterial pressure and cardiac output on 30 min [（117 ± 8）,（56± 10）,（45 ± 4）,（31 ± 5） mm Hg,（4.80 ± 0.54）,（3.32 ± 0.32）,（2.35 ± 0.37）,（1.67 ± 0.15） L / min], 1 h[（123 ± 4）,（89 ± 6）,（67 ± 8）,（52 ± 8） mm Hg,（4.79 ± 0.63）,（3.99 ± 0.37）,（2.75 ± 0.35）,（2.05 ± 0.39）L / min] after hemorrhage decreased（all P〈0.05）, blood lactic acid on 1 h after hemorrhage increased [（1.12 ± 0.33）,（2.10 ± 0.25）,（3.74 ± 1.38）,（5.88 ± 1.48） mmol / L; all P〈0.05], and MFI [（2.92 ± 0.09）,（2.47 ± 0.28）,（1.30 ± 0.14）,（0.87 ± 0.27）; all P〈0.05] and PVD [（4.95 ± 0.12）,（4.20 ± 0.54）,（2.98 ± 0.10）,（2.64 ± 0.31）; all P〈0.05] on 30 min after hemorrhage declined.Pearson correlationanalysis showed that MFI and PVD were positively associated with mean arterial pressure（r = 0.903, 0.923; all P〈0.05） and cardiac output（r = 0.919, 0.919; all P〈0.05）, and negatively correlate

关 键 词：微循环 猪 失血 微血管流动指数 灌注血管密度 

分 类 号：R641[医药卫生—外科学]