不同复苏液在失血性休克模型中抗休克效果研究  

Antishock effect of different resuscitation fluid on hemorrhagic shock model

作　　者：张贺 雷建军 王馨培 田竞 李雪华 ZHANG He;LEI Jian-jun;WANG Xin-pei;TIAN Jing;LI Xue-hua(Laboratory Animal Laboratory,General Hospital of Northern Theater Command,Shenyang 110016;Health Service Training Center,General Hospital of Northern Theater Command,Shenyang 110016)

机构地区：[1]北部战区总医院实验动物室,辽宁沈阳110016 [2]北部战区总医院卫勤训练中心,辽宁沈阳110016

出　　处：《临床军医杂志》2023年第3期235-239,242,共6页Clinical Journal of Medical Officers

基　　金：军队后勤科研计划实验动物专项项目[SYDW(2018)09]。

摘　　要：目的 探讨不同复苏液在失血性休克模型中的抗休克效果。方法 选取12只成年普通级雄性健康巴马猪为研究对象,采用随机数字表法将其分为A组和B组,每组各6只。A组使用生理盐水进行液体复苏,B组使用羟乙基淀粉电解质溶液进行液体复苏。比较两组的复苏用时,液体平衡状态,输液前(T_(0))、输液即刻(T_(1))、输液完成时(T_(2))、输液完成后60 min(T_(3))的血气指标,体循环血流动力学及微循环中的灌注血管密度、微血管血流指数、灌注血管百分比等。结果 B组复苏时间、输液量、尿量、液体平衡差低于A组,两组比较,差异有统计学意义(P<0.05)。B组复苏后平均动脉压高于A组,两组比较,差异有统计学意义(P<0.05)。两组T_(0)、T_(1)、T_(2)、T_(3)时钠离子、钾离子、钙离子、pH值比较,差异无统计学意义(P>0.05)。A组T_(3)时氯离子高于B组,BE值低于B组,差异有统计学意义(P<0.05)。B组液体复苏后灌注血管密度、微血管血流指数、灌注血管比例高于A组,两组比较,差异均有统计学意义(P<0.05)。结论 失血性休克复苏后,体循环与微循环血流动力学变化趋势不一致提示预后不良。羟乙基淀粉电解质溶液可改善失血性休克体循环和微循环状态,保持血流动力学一致性。生理盐水能使体循环血流动力学正常,但灌注血管密度降低,易导致微循环能力恶化。Objective To investigate the antishock effect of different resuscitation fluids in hemorrhagic shock model.Methods A total of 20 healthy adult male Bama pigs were selected as the study subjects and divided into group A and group B by random number table method,with 6 pigs in each group.Group A with normal saline for liquid resuscitation,group B with hydroxyethyl starch electrolyte solution.The resuscitation time,fluid balance state,blood gas indexes before infusion(T_(0)),immediately infusion(T_(1)),at completion of infusion(T_(2)),and 60 min after infusion(T_(3)),the density of perfusion vessels in systemic hemodynamics and microcirculation,vascular blood flow index,and percentage of perfusion vessels were compared between the two groups.Results The resuscitation time,infusion volume,urine volume and fluid balance difference of group B were lower than those of group A,and the differences between the two groups were statistically significant(P<0.05).The mean arterial pressure after resuscitation in group B was higher than that in group A,and the difference was statistically significant(P<0.05).There was no significant difference in sodium ion,potassium ion,calcium ion and pH value at T_(0),T_(1),T_(2) and T_(3) between the two groups(P>0.05).The chloride ion in group A was higher than that in group B at T_(3),and the BE value was lower than that in group B,the differences were statistically significant(P<0.05).After liquid resuscitation,perfusion vascular density,microvascular blood flow index and perfusion vascular ratio in group B were higher than those in group A,and the differences were statistically significant(P<0.05).Conclusion The discordant hemodynamics of systemic and microcirculatory hemodynamics after resuscitation from hemorrhagic shock suggests a poor prognosis.Hydroxyethyl starch electrolyte solution can improve systemic circulation and microcirculation and maintain hemodynamic consistency.Normal saline can normalize the hemodynamics of systemic circulation,but the decreased perfusion vessel densit

关 键 词：失血性休克 巴马猪 液体复苏 体循环 微循环 

分 类 号：R441.9[医药卫生—诊断学] R8[医药卫生—临床医学]