液体复苏对腹腔高压家猪血流动力学及脑灌注的影响  

Evaluate the effects of fluid loading on hemodynamics and cerebral perfusion under different levels of intra.abdominal pressure

作　　者：祁慧[1] 顾勤[1] 刘宁[1] 徐颖[1] 韩云宏[1] 张北源[1] 

机构地区：[1]南京大学附属鼓楼医院重症医学科,南京210093

出　　处：《中华急诊医学杂志》2017年第5期528-532,共5页Chinese Journal of Emergency Medicine

基　　金：南京市医学科技发展项目（YKK08071）

摘　　要：目的探讨液体复苏对腹腔高压（IAH）家猪血流动力学及脑灌注（CPP）的影响。方法选择实验家猪40只，经颈动脉释放家猪30%血容量，维持家猪低血容量状态，按随机数字表法随机分为四组，采用氮气（N2）气腹法分别维持腹腔压力（IAP）为0、15、25和35 mmHg即IAPL0组、IAPL15组、IAPL25组和IAPL35组，各组均在30 min内快速静脉输注羟乙基淀粉500 mL进行液体复苏，采用PiCCO法分别于复苏前及复苏后30 min监测各组家猪心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、心排指数（CI）、全心舒张末期容积指数（GEDVI）和每搏输出量指数（SVI）等血流动力学指标，脑室内置入颅内压光纤探头，连接颅内压监测仪连续监测颅内压（ICP）变化，计算CPP。结果（1）IAPL0组、IAPL15组、IAPL25组和IAPL35组经液体复苏后均表现为HR下降，MAP升高，CI、GEDVI和SVI增加（均P〈0.05）, CVP则无明显变化（P〉0.05）, IAPL15组、IAPL25组和IAPL35组@@SVRI显著下降（均P〈0.05）；各组@@EVLWI无明显变化（均P〉0.05）；（2）IAPL0组、IAPL15组、IAPL25组和IAPL35组，液体复苏后ICP均显著升高（均P〈0.05），IAPL25和IAPL35组CPP亦显著增加（均P〈0.05），而IAPL15组CPP呈上升趋势（P〉0.05）。结论腹腔高压时，液体复苏可以增加低血容量家猪的心排血量，改善家猪循环状态及脑灌注。Objective To study the effects of fluid loading during fluid resuscitation on hemodynamics and cerebral perfusion （CPP） under different levels of intra-abdominal pressure （IAP）. Methods Forty swine were employed in the study. Hypovolemia was made by blood withdrawal of 30% of estimated blood volume from each animal through the carotid artery line. All swine were randomized （random number） into four groups, namely IAP10, IAP115, IAPL25 and IAP135. Then N2 gas was used to inflate in the abdomen slowly for elevating the lAP to 0, 15, 25 and 35 mmHg. Fluid loading were performed with 500 mL hydroxyethyl starch within 30 minutes. Hemodynamic variables were evaluated by PiCCO. Heart rate （ HR）, mean arterial pressure （ MAP）, central venous pressure （ CVP）, cardiac output （CO）, global end-diastolic volume index （GEDVI） and stroke volume index （SVI） were measured 30 minutes before fluid loading and 30 minutes after fluid loading. After placement of intracranial pressure optical fiber probe in the ventricle connected to intracranial pressure monitor for continuous monitoring of ICP changes, cerebral perfusion pressure （CPP） could be calculated. Results （1） HR decrease, MAP increased, SVI, CI and GEDVI significantly increased after fluid loading in aU four groups （ IAP10, IAP115,IAP125 and IAP135 ） （P 〈 0.05 ）, and there were not significant changes in CVP and EVLWI （P 〉 0. 05 ）. SVRI decreased significantly in group IAP115, IAP125 and IAP135 respectively （P 〈 0. 05 ）. （2） ICP increased significantly in group IAP115, IAP125 and IAP135 （P 〈 0.05）, and CPP increased significantly in group IAP125 and IAPL35 （ P 〈 0. 05 ） while CPP only slightly increased in group IAP115 （ P 〉 0. 05 ）. Conclusion When combined with intra-abdominal hypertension, fluid loading could improve the circulation of swine due to increase in CO and improve CPP.

关 键 词：腹腔高压 心排血量 液体复苏 每搏输出量变异 颅内压 脑灌注压 

分 类 号：R459.7[医药卫生—急诊医学]