低温海水浸泡合并失血休克对大鼠致死三联征及器官功能的影响  

Lethal triad and multi-organ dysfunction in rats following cold seawater bath and hemorrhagic shock

作　　者：刘艳丽 田昆仑 朱娱 吴跃 刘良明 刘蕾 LIU Yanli;TIAN Kunlun;ZHU Yu;WU Yue;LIU Liangming;LIU Lei(Department of Nursing,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400038;Second Research Department,Institute of Surgery Research,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学第一附属医院护理处,重庆400038 [2]陆军军医大学野战外科研究所第二研究室,重庆400038

出　　处：《第三军医大学学报》2020年第8期752-757,共6页Journal of Third Military Medical University

摘　　要：目的观察低温海水浸泡合并失血休克对SD大鼠致死三联征、器官功能、生存时间的影响。方法雄性SD大鼠放入15℃海水中开始放血,失血量为全身血量的40%,持续浸泡2 h。造模成功后4 h检测血气、凝血功能及重要脏器功能的变化,并观察大鼠72 h的存活情况。结果40%失血休克后大鼠的核心体温、PH仅在正常范围内波动,脏器功能部分受损;单纯低温海水浸泡可导致大鼠核心体温快速降低、凝血功能障碍、重要脏器的血液指标明显增高,死亡率增加;而低温海水浸泡对失血休克大鼠影响更为显著:大鼠核心体温直降至33℃,即使脱离低温环境,仍无法自行恢复;血气结果显示:PH降至7.17,其余酸碱指标不同程度降低,大鼠呈代谢性酸中毒状态;凝血功能结果显示:大鼠PT、APTT明显延长,FIB明显降低,INR显著增高,大鼠出现严重的凝血功能障碍。海水浸泡同样引起失血休克大鼠的心、肝、肾等脏器功能的血液指标明显升高,多器官功能严重受损,存活率降低至3/16,存活时间缩短至21.7 h。结论低温海水浸泡导致失血休克大鼠的致死三联征高发、重要脏器功能受损、死亡率增高。Objective To investigate the effect of hypothermia induced by cold seawater bath and hemorrhagic shock on lethal triad,vital organ dysfunction and survival time in rats.Methods Male SD rats were subjected to cold(15℃)seawater bath for 2 h or blood extraction of 40%of the total blood volume from the right carotid artery,or both treatments.Blood gas,blood coagulation function and vital organ functions were detected at 4 h after successful modeling,and the survival of the rats at 72 h was observed.Results A 40%blood loss caused the core body temperature and pH value to fluctuate mildly within the normal range and partial impairment the organ functions of the rats.Cold seawater bath for 2 h resulted in rapid onset of hypothermia,coagulation dysfunction,organ function damages and a high mortality rate of the rats.Cold seawater bath further exacerbated the detrimental effects of hemorrhagic shock to cause the core body temperature to drop to 33℃,which failed to recover the normal temperature even after the bath.Blood gas analysis showed that cold seawater bath and hemorrhagic shock combined lowered the pH value to 7.17 and reduced the other acid and base indexes,indicating the onset of metabolic acidosis;the combined treatment also induced coagulation dysfunctions shown by obviously prolonged prothrombin time(PT)and activated partial thrombinplastin time(APTT),significantly decreased fibrinogen(FIB),and significantly increased international normalized ratio(INR).In addition,cold seawater bath significantly increased the blood parameters for the heart,liver and kidney functions in rats with hemorrhagic shock,suggesting severe functional damage of multiple organs.The survival rate was reduced to 3/16 and the survival time was shortened to 21.7 h in the rats exposed to the combined treatment.Conclusion Cold seawater bath causes a high incidence of fatal triad,induces functional impairment of the vital organs and increases the mortality of the rats with hemorrhagic shock.

关 键 词：海水浸泡 失血休克 致死三联征 器官功能障碍 

分 类 号：R-332[医药卫生] R605.971