非控制性出血休克大鼠早期低压液体复苏的理想复苏压力研究
非控制性出血休克；,,早期救治；,液体复苏；,复苏压力,材料与方法,1动物模型制备,2实验设计及指标检测,3统计学处理,结果,讨论,参考文
摘要： 目的 利用大鼠非控制性出血休克模型，探讨早期低压复苏的理想复苏压力。方法 Wistar大鼠64只，基础平均动脉血压(MAP)为(129.9±14.3)mmHg,断脾法复制非控制性出血休克模型，将血压(MAP)降至40或50 mmHg，分为3个处理时段，第一时段模拟院前救治时段， 用2∶1乳酸林格氏液和6%的右旋糖酐输注分别将MAP维持在40、50、60、70、80、100 mmHg，维持1小时； 第二时段模拟医院确定性处理， 结扎脾动脉止血，输血输液将MAP恢复至100 mmHg，维持2小时； 第三时段，观察第一时段不同压力复苏对休克复苏效果的影响。观察指标包括动物存活时间、血压、液体输注量、血球压积及动脉血气等。结果 院前急救采用高压复苏(80、100mmHg)动物存活时间短，在第一时段末就有50%的动物死亡，需要的液体输注量大， 血液稀释严重，代谢性酸中毒明显，血气指标差； 而以低于70mmHg(50、60、70mmHg)的血压复苏，动物存活时间延长，液体输注量小，血液稀释轻，血气指标正常或接近正常； 以50、60 mmHg血压输注效果最好，但太低的输注压力(40mmHg)也不利于休克复苏。在第三时段末动物死亡率为75%。结论 对非控制性出血休克及活动性出血，止血前采用高压复苏会增加血液丢失，增加血液稀释， 明显影响休克复苏效果，适当低压复苏有利于动物的后期复苏效果， 输注压力以50、60mmHg最好，但太低的输注压力(40mmHg)也不利于休克复苏。关键词： 早期救治； 液体复苏； 复苏压力
Ideal pressure of fluid resuscitation for early treatment of uncontrolled hemorrhagic shock in rats
LIU liangming, DIAO youfang, LI Ping,et al.
(State Key Laboratory of Trauma, Burns and Combined Injury, Department 2, Research Institute of Surgery, Daping Hospital,The Third Military Medical University, Chongqing 400042,China)
Abstract: Objective To explore the ideal fluid resuscitation pressure for early treatment of uncontrolled hemorrhagic shock. Methods Sixty four Wistar rats were anesthetized with sodium pentobarbital. Uncontrolled hemorrhagic shock was produced by spleen amputation, and the mean arterial blood pressure(MAP) was dropped to 40 or 50 mmHg. The management was distributed into 3 stages.The mimicked prehospital emergency was the first stage,during which the shocked rats were resuscitated with lactated Ringer's solution and 6% dextran to make MAP 40,50,60,70,80 and 100 mmHg for 1 hour respectively. The mimicked definitive treatment of hospital was the second stage,during which spleen artery was ligated and the rats was resuscitated to make MAP 100 mmHg for 2 hours with fluid and blood. The resuscitation effect observation was the third stage,during which the animal survival time, MAP, the amount of infused fluid, the hematocrit and arterial blood gases was observed. Results The survival time was short in the animals (hypertensive 80,100 mmHg) at the first stage, most of animals died during the second and the third stage. The animals had severe hemodilution and metabolic acidosis, their blood gases were inferior to the hypotensive resuscitation groups. In contrast, the animals in the hypotensive (50,60,70 mmHg) resuscitation groups at the first stage survived longer. Their hemodilution was not severe and their blood gases were normal,or close to normal. The resuscitation effect of 50 and 60 mmHg was the best. Too low resuscitation pressure (40 mmHg) was not reasonable for shock resuscitation, in which the mortality was also higher. Conclusion Hypertensive resuscitation for uncontrolled hemorrhagic shock in prehospital phase will increase the blood loss,hemodilution and interfere with the resuscitation effect of shock. Hypotensive resuscitation in prehospital will benefit to shock resuscitation. The ideal infusion pressure was to keep MAP at 50-60 mmHg. Too low resuscitation pressure was not ideal for shock resuscitation. ......
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