用侧流暗场成像技术观察不同目标血压的内毒素休克兔小肠绒毛微循环变化  

Changes of small intestinal villi microcirculation in sidestream dark-field imaging with different target blood pressure in rabbits during endotoxin shock

作　　者：高飞[1] 傅小云[1] 钱明江[1] 张宇 李光素 胡杰[1] 

机构地区：[1]遵义医学院附属医院重症医学科,贵州遵义563003 [2]贵州省麻醉与器官保护重点实验室,贵州遵义563003 [3]遵义医学院研究生院,贵州遵义563003

出　　处：《中华危重病急救医学》2017年第4期311-315,共5页Chinese Critical Care Medicine

摘　　要：目的 采用侧流暗场成像（SDF）技术监测液体复苏至不同目标血压内毒素休克兔小肠绒毛微循环的变化,评价用SDF监测小肠绒毛微循环的可行性.方法 按随机数字表法将新西兰大白兔分为低目标血压组和高目标血压组,每组30只.两组均行体外回肠造口术,经股静脉注射脂多糖（LPS）2 mg/kg建立内毒素休克模型.制模成功后,低目标血压组以乳酸林格液20 mL·kg^-1·h^-1进行液体复苏,使平均动脉压（MAP）达到65 mmHg（1 mmHg=0.133 kPa）;高目标血压组以乳酸林格液30 mL·kg^-1·h^-1进行液体复苏,使MAP达到80 mmHg.采用SDF技术持续监测小肠绒毛微循环灌注指标,记录休克前、休克后及液体复苏后的绒毛微血管数、灌注绒毛比例、绒毛微血管血流指数（MFI）、绒毛边界评分（BVS）、绒毛微血管评分（VVS）等,参照2014年荷兰圆桌会议推荐的小肠绒毛微循环参数评价系统,进行小肠绒毛微循环损伤评分及损伤严重程度分级.结果 两组休克前小肠绒毛微血管清晰,结构完整.两组休克后绒毛微血管均较休克前明显减少,灌注绒毛比例明显下降,绒毛结构破坏,MFI、BVS、VVS及肠绒毛微循环损伤总分明显下降,均为重度损伤.两组液体复苏后绒毛微循环部分血流有所恢复,但部分区域微血管灌注不均衡,绒毛结构仍不清;与休克后比较,低目标血压组和高目标血压组液体复苏后绒毛微血管明显增多（条：1.21±0.22比0.81±0.12,1.54±0.28比0.79±0.13）,灌注绒毛比例〔（31±4）%比（12±2）%,（38±5）%比（13±3）%〕、MFI（1.55±0.09比1.09±0.03,1.97±0.11比1.05±0.03）、VVS（分：1.22±0.08比0.89±0.02,2.06±0.15比0.90±0.02）及绒毛微循环损伤总分（分：3.70±0.19比2.85±0.07,5.01±0.29比2.88±0.08）均明显升高（均P〈0.05）,且高目标血压组上述指标恢复情况均优于低目标血压组,损伤程度减轻;而两组BVS较休克后无明显增加（分：0.93�Objective Changes of small intestine villus microcirculation perfusion in sidestream dark-field （SDF） imaging in the rabbits during endotoxic shock after fluid resuscitation with different target mean arterial pressure （MAP）, and evaluation of feasibility of monitoring small intestine villus microcirculation by SDF were studied. Methods Sixty standard New Zealand white rabbits were randomly divided into two groups： low target MAP group （group A, n = 30） and high target MAP group （group B,n = 30）. Fistula operation of ileum was madein vitro, and lipopolysaccharide （LPS, 2 mg/kg） was injected to establish endotoxic shock model. Group A was administered with the lower dose fluid resuscitation （lactated Ringer solution, 20 mL·kg^-1·h^-1） for target MAP of 65 mmHg （1 mmHg =0.133 kPa）; group B was administered with the higher dose fluid resuscitation （lactated Ringer solution, 30 mL·kg^-1·h^-1） for MAP of 80 mmHg. Continuous norepinephrine intravenous injection （0.5-1.0μg·kg^-1·min-1） was administered only after fluid therapy couldn＇t reach the target MAP. The changes of small intestine villus microcirculation perfusion indexes such as vessels per villus （VV）, proportion of perfused villi （PPV）, microvascular flow index （MFI）, borders of villus score （BVS）, vessels villus score （VVS） were continuously observed and recorded before the shock, during the shock and after fluid resuscitation using SDF imaging. The differences of microcirculation perfusion were compared between two groups using the specific parameter evaluation system to determine severity of villi microcirculation and injury scores at different stages.Results VV and borders of villus were clear and contact before shock in two groups. After shock, VV, PPV were significantly decreased in both two groups, the borders of villus were destroyed, MFI, BVS, VVS and the total score of villi injury microcirculation were obviously and severely decreased. Partial blood flow of villous capillaries after

关 键 词：侧流暗场成像技术 微循环 小肠绒毛 内毒素休克 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]