精氨酸血管加压素对海水浸泡合并非控制性失血休克大鼠复苏效果的观察  

Effect of arginine vasopressin on resuscitation of rats with uncontrolled hemorrhagic shock after seawater immersion

作　　者：王莉 周孝伟 彭小勇 田昆仑 刘良明 李涛 Wang Li;Zhou Xiaowei;Peng Xiaoyong;Tian Kunlun;Liu Liangming;Li Tao(State Key Laboratory of Trauma,Burn and Combined injury,Department of Shock and Blood Transfusion,Daping Hospital,Army Medical University,Chongqing,400042,China)

机构地区：[1]陆军军医大学大坪医院战伤休克与输血研究室,创伤、烧伤与复合伤国家重点实验室,重庆400042

出　　处：《创伤外科杂志》2021年第10期775-780,共6页Journal of Traumatic Surgery

基　　金：全军“十三五重大项目”(AWS16J032)。

摘　　要：目的观察精氨酸血管加压素(AVP)对海水浸泡合并非控制性失血休克大鼠的复苏效果。方法采用15℃低温海水联合脾切除的非控制性失血休克Sprague-Dawley(SD)雄性大鼠72只,14~16周龄,体重(230±20)g,按随机数字表法将大鼠分为单纯乳酸林格液(LR)复苏对照组(LR组),去甲肾上腺素(NE)联合LR复苏组(NE组)、AVP联合LR复苏组(AVP组),各24只。休克后各实验组大鼠分别静脉输注LR、NE(5μg/kg)+LR以及AVP(0.1U/kg)+LR。观察AVP对休克大鼠失血率、复苏液体量、凝血功能、酸中毒及存活的影响。结果经海水浸泡合并非控制性失血休克后,在彻底止血前低压复苏阶段AVP组失血率(49±3.6)%较LR组大鼠失血率(52±6.0)%减少,NE组失血率较LR组增加。确定性治疗阶段AVP组复苏液体量(32.9±2.23)mL较LR组复苏液体量(66.7±5.63)mL显著降低(P<0.01),NE组复苏液体量(47.0±3.50)mL减少,但与LR组比较无显著差异(P>0.05)。复苏结束后,AVP组凝血功能显著改善,表现为凝血酶原时间国际化比值(PT-INR)、凝血酶原时间(PT)较LR组显著缩短(P<0.05,P<0.01),分别为(2.0±0.11)s和(23.2±1.20)s;NE组凝血功能改善不显著(P>0.05)。血气分析提示各组大鼠pH值均恢复至7.3左右,AVP组氧分压(PaO 2)较LR组和NE组有一定程度增加,至(153.0±14.49)mmHg。AVP组平均存活时间显著延长至26h,24h存活率为50%;NE组和LR组平均存活时间分别为20h和16h,24h存活率均仅为25%。结论AVP能显著减少海水浸泡合并非控制性失血休克大鼠的失血率和输液量,改善凝血功能和血气,延长存活时间,提高存活率。Objective To observe the resuscitation effect of arginine vasopressin(AVP)on rats with uncontrolled hemorrhagic shock after seawater immersion.Methods The model of uncontrolled hemorrhagic shock was established by 15℃hypothermic seawater combined with splenectomy.Seventy-two SD rats were randomly divided into simple lactate ringer fluid resuscitation control group(LR group),norepinephrine(NE)combined with lactate ringer fluid resuscitation group(NE group)and AVP combined with lactate ringer fluid resuscitation group(AVP group),with 24 rats in each group.After shock,the rats in each group were infused with LR,NE(5μg/kg)+LR and AVP(0.1U/kg)+LR.The effects of AVP on blood loss rate,resuscitation fluid volume,coagulation function,acidosis and survival in shock rats were observed.Results After seawater immersion combined with uncontrolled hemorrhagic shock,the blood loss rate of AVP group(49±3.6)% was lower than that of LR group(52±6.0)%,and that of NE group(55±4.2)% was higher than that of LR group.In the definite treatment stage,the volume of resuscitation fluid in AVP group was(32.9±2.23)mL,which was significantly lower than that in LR group(66.7±5.63)mL,P<0.01.The volume of resuscitation fluid in NE group(47.0±3.50)mL had no significant difference compared with LR group(P>0.05).After fluid resuscitation,the coagulation function of rats in AVP group was significantly improved after resuscitation,which showed that the international ratio of prothrombin time(PT-INR)and prothrombin time(PT)were significantly shorter than those in LR group(P<0.05,P<0.01),which were(2.0±0.11)s and(23.2±1.20)s,respectively.There was no significant improvement in coagulation function in NE group(P>0.05).Blood gas analysis showed that the pH value of rats in each group recovered to about 7.3.PaO 2 in AVP group increased to(153.0±14.49)mmHg compared with LR group and NE group.The average survival time of rats in AVP group was significantly prolonged to 26 hours,and the 24-hour survival rate was 50%.The average survival time of r

关 键 词：非控制性失血休克 精氨酸血管加压素 海水浸泡 复苏 大鼠 

分 类 号：R459.7[医药卫生—急诊医学]