连续性静-静脉血液滤过对内毒素休克羊血流动力学的影响
胡振杰 刘丽霞 孙莉霄 李勇【摘要】 目的: 探讨连续性静-静脉血液滤过(CVVH)对内毒素休克血流动力学的影响及作用机制，并观察其对内毒素休克预后的影响。方法: 利用大肠杆菌内毒素(L-2880)诱导绵羊内毒素休克模型，随机分为对照组(NHF)和治疗组(HF)两组，观察CVVH(零平衡，40 ml·kg-1·h-1超滤，血流速80 ml/min)对内毒素休克羊血流动力学的影响。结果: 内毒素注入后两组实验动物平均动脉压(MAP)明显下降；平均肺动脉压(MPAP)、心脏指数(CI)显著升高(P<0.01或P<0.05)。实施CVVH后，HF组MAP、每搏量(SV)明显上升，显著高于NHF组(P<0.01或P<0.05)；HF组CI无明显变化，NHF组进行性下降并显著低于HF组(P<0.05)；两组MPAP差异无显著性(P>0.05)；血浆乳酸浓度NHF组明显高于HF组。5 h后HF组全部存活，NHF组死亡2只。结论: 应用大肠杆菌内毒素静脉注射可成功制备羊内毒素休克模型；CVVH具有改善内毒素休克血流动力学和预后的作用，是治疗内毒素休克的重要手段。
【关键词】 内毒素休克； 连续性静-静脉血液滤过； 血流动力学； 炎性介质
Effects of continuous veno-venous hemofiltration on the hemodynamics of sheep with endotoxic shock
HU Zhen-jie, LIU Li-xia, SUN Li-xiao, LI Yong.
ICU, the Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei China
【Abstract】 OBJECTIVE: To study the influence of continuous veno-venous hemofiltration (CVVH) on the hemodynamics and the prognosis of sheep with endotoxic shock. METHODS: Endotoxic shock was induced by intravenous infusion of lipopolysaccharide, L-2880, to sheep, and the animals were randomly divided to control group (NHF, endotoxin only) or treatment group (HF, endotoxin+CVVH). In the latter groups a zero-balanced CVVH was instituted with an ultrafiltration rate of 40 ml·kg-1·h-1and a blood flow rate of 80 ml/min. The hemodynamic parameters were monitered. RESULTS: After the administration of endotoxin, the mean arterial pressure (MAP) was decreased significantly, while mean pulmonary artery pressure (MPAP) and cardiac index (CI) increased significantly in both groups (P<0.05 or P<0.01). With CVVH, MAP and stroke volume (SV) were increased significantly, and were significantly higher than that of NHF group (P<0.05 or P<0.01). CI declined progressively in NHF group and significantly lower than that of HF group, in which there was no significant change(P<0.05). No significant difference in MPAP was found between two groups(P>0.05). Moreover, plasma lactate levels were lower in NHF group than in HF group (P<0.05). After 5 hours, the sheep in HF group all survived, and 2 sheep of NHF group died. CONCLUSION: Intraveous infusion of endotoxin could produce endotoxic shock in sheep. CVVH was shown to have a beneficial effect on the hemodynamics, and it gave a better prognosis in endotoxic, indicating that it might be important method to treat endotoxic shock. ......
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