淡水与海水淹溺后绵羊体循环病理生理学参数变化的对照研究  

Systemic pathologic physiology parameters changes in sheep drowning： a control study in freshwater and seawater

作　　者：杨万杰[1] 冯庆国[1] 刘晓智[2] 王晴[1] 赵雪峰[1] 张茹梅[1] 魏凯[1] 滕洪云 王玉梅[1] 

机构地区：[1]天津市第五中心医院重症医学科,300450 [2]天津市第五中心医院中心实验室,300450

出　　处：《中华危重病急救医学》2018年第1期18-23,共6页Chinese Critical Care Medicine

基　　金：天津市滨海新区塘沽科技兴区项目（2013KJXQ01）

摘　　要：目的 比较淡水与海水淹溺后绵羊体循环病理生理学参数的变化.方法 将24只健康杂种绵羊按随机数字表法分为两组,每组12只.于机械通气和镇痛镇静状态下,分别将海水或淡水10~25 mL/kg经动物气管导管内注入以制备淹溺模型.观察两组动物淹溺前、淹溺即刻（注水完毕后）及淹溺后30、60、120 min血流动力学指标的变化;记录淹溺后尿液颜色变化及发生时间;于淹溺后120 min处死动物取心脏、肾脏、肝脏、脾脏和小肠进行苏木素-伊红（HE）染色,光镜下观察组织病理学改变.结果 ① 体循环血流动力学变化：两组淹溺前各项血流动力学指标间比较差异均无统计学意义.与淹溺前比较,淡水组和海水组淹溺即刻心率（HR）、平均动脉压（MAP）、心排血量（CO）、左室最大收缩力指数（dPmax）和肺动脉楔压（PAWP）均明显升高,并随淹溺后时间延长呈下降趋势.与淹溺即刻比较,淡水淹溺后30 min动物dPmax即明显降低（mmHg/s：919.83±14.51比2628.42±59.75,P〈0.01）,并低于淹溺前水平,直至120 min;淹溺后30 min CO虽较淹溺即刻有所回落,但仍明显高于淹溺前水平（L/min：8.25±0.66比5.75±0.73,P〈0.01）;全心舒张期末容积（GEDV）和PAWP于淹溺后120 min降至淹溺前水平〔GEDV（mL）：642.92±7.29比638.25±7.00,PAWP （mmHg,1 mmHg=0.133 kPa）：5.83±1.19比5.42±1.08,均P〉0.05〕.与淹溺即刻比较,海水淹溺后30 min动物MAP、CO和PAWP即明显降低〔MAP（mmHg）：90.50±3.58比159.42±3.18,CO（L/min）：2.37±0.45比10.33±0.73,PAWP（mmHg）：4.17±0.72比11.75±1.82,均P〈0.01〕,且低于淹溺前水平,直至120 min.淹溺后30 min,海水组MAP、CO和PAWP即明显低于淡水组〔MAP（mmHg）：90.50±3.58比117.42±1.78,CO（L/min）：2.37±0.45比8.25±0.66,PAWP（mmHg）：4.17±0.72比24.83±1.27〕,dPmax即明显高于淡水组（mmHg/s：1251.42±62.50比919.83±14.51,均P〈0.01）,并持续至120 min.两组淹溺�envelope method, 24 sheep were randomly divided into two groups, with 12 animals in each group. The animals in both groups were subjected to mechanical ventilation and analgesia and sedation, the drowning models were reproduced by injecting 10-25 mL/kg of seawater or freshwater into the endotracheal tube of animals. The changes in hemodynamics before drowning, immediately after drowning （immediately after water injection） and 30, 60, and 120 minutes after drowning in both groups were recorded. The urine color changes after drowning and occurrence time were recorded. The animals were sacrificed at 120 minutes after drowning, and heart, kidney, liver, spleen and intestine were harvested for pathological observation under light microscope using hematoxylin and eosin （HE） staining. Results ① The changes in systemic hemodynamic： there was no significant difference in hemodynamics before drowning between the two groups.Compared with before drowning, heart rate （HR）, mean arterial pressure （MAP）, cardiac output （CO）, left ventricular maximum systolic force index （dPmax）, and pulmonary wedge pressure （PAWP） immediately after drowning in both seawater and freshwater groups were significantly increased, which showed a decrease tendency with drowning time prolongation. Compared with drowning immediately, dPmax at 30 minutes after freshwater drowning was significantly decreased （mmHg/s： 919.83±14.51 vs. 2 628.42±59.75, P 〈 0.01）, which was below the level before drowning till 120 minutes. CO at 30 minutes after freshwater drowning was retreated as compared with drowning immediately, but it was still higher than that before drowning （L/min： 8.25±0.66 vs. 5.75±0.73, P 〈 0.01）. Global end-diastolic volume （GEDV） and PAWP at 120 minutes after freshwater drowning were decreased to the level before drowning [GEDV （mL）： 642.92±7.29 vs. 638.25±7.00, PAWP （mmHg, 1 mmHg = 0.133 kPa）： 5.83±1.19 vs. 5.42±1.08, both P 〉 0.05]. Compared with immediately after drowni

关 键 词：淹溺 淡水 海水 血容量 溶血 

分 类 号：R649.3[医药卫生—外科学]