中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2010年
7期
823-825
,共3页
补液疗法%休克,脓毒性%全身炎症反应综合征
補液療法%休剋,膿毒性%全身炎癥反應綜閤徵
보액요법%휴극,농독성%전신염증반응종합정
Fluid therapy%Shock,septic%Systemic inflammatory response syndrome
目的 探讨不同液体治疗对感染性休克新生兔全身炎性反应的影响.方法 健康新西兰长耳新生兔100只,采用盲肠结扎穿孔(CLP)法制备感染性休克模型,随机分为5组(n=20):假手术组(S组)、CLP组、乳酸钠林格氏液组(R组)、乳酸钠林格氏液+6%羟乙基淀粉组(R+HES组)和6%羟乙基淀粉组(HES组).CLP后即刻,R组静脉输注乳酸钠林格氏液30 ml/kg 1 h;R+HES组依次静脉输注乳酸钠林格氏液20 ml/kg 40 min和6%羟乙基淀粉10 ml/kg 20 min;HES组静脉输注6%羟乙基淀粉30 ml/kg 1 h.于CLP后即刻、0.5、1、2、4、8 h(T1～6)时记录MAP.于T6时取颈总动脉血样,测定血浆IL-6和IL-10的浓度.结果 与T1时比较,CLP组T4～6时MAP降低,R组T5.6时MAP降低(P＜0.05),其余各组差异无统计学意义(P＞0.05).与S组比较,CLP组MAP降低,血浆IL-6浓度升高,IL-10浓度降低,R组MAP降低,血浆IL-6浓度升高,HES组血浆IL-10浓度升高(P＜0.05).与CLP组比较,R+HES组和HES组血浆IL-6浓度降低,IL-10浓度升高,R组血浆IL-10浓度升高(P＜0.05).结论 新生兔感染性休克早期静脉输注乳酸钠林格氏液与6%羟乙基淀粉(2∶1)治疗,有利于维持促炎细胞因子和抑炎细胞因子的平衡,从而减轻全身炎性反应,其效果优于单独静脉输注乳酸钠林格氏液或6%羟乙基淀粉.
目的 探討不同液體治療對感染性休剋新生兔全身炎性反應的影響.方法 健康新西蘭長耳新生兔100隻,採用盲腸結扎穿孔(CLP)法製備感染性休剋模型,隨機分為5組(n=20):假手術組(S組)、CLP組、乳痠鈉林格氏液組(R組)、乳痠鈉林格氏液+6%羥乙基澱粉組(R+HES組)和6%羥乙基澱粉組(HES組).CLP後即刻,R組靜脈輸註乳痠鈉林格氏液30 ml/kg 1 h;R+HES組依次靜脈輸註乳痠鈉林格氏液20 ml/kg 40 min和6%羥乙基澱粉10 ml/kg 20 min;HES組靜脈輸註6%羥乙基澱粉30 ml/kg 1 h.于CLP後即刻、0.5、1、2、4、8 h(T1～6)時記錄MAP.于T6時取頸總動脈血樣,測定血漿IL-6和IL-10的濃度.結果 與T1時比較,CLP組T4～6時MAP降低,R組T5.6時MAP降低(P＜0.05),其餘各組差異無統計學意義(P＞0.05).與S組比較,CLP組MAP降低,血漿IL-6濃度升高,IL-10濃度降低,R組MAP降低,血漿IL-6濃度升高,HES組血漿IL-10濃度升高(P＜0.05).與CLP組比較,R+HES組和HES組血漿IL-6濃度降低,IL-10濃度升高,R組血漿IL-10濃度升高(P＜0.05).結論 新生兔感染性休剋早期靜脈輸註乳痠鈉林格氏液與6%羥乙基澱粉(2∶1)治療,有利于維持促炎細胞因子和抑炎細胞因子的平衡,從而減輕全身炎性反應,其效果優于單獨靜脈輸註乳痠鈉林格氏液或6%羥乙基澱粉.
목적 탐토불동액체치료대감염성휴극신생토전신염성반응적영향.방법 건강신서란장이신생토100지,채용맹장결찰천공(CLP)법제비감염성휴극모형,수궤분위5조(n=20):가수술조(S조)、CLP조、유산납림격씨액조(R조)、유산납림격씨액+6%간을기정분조(R+HES조)화6%간을기정분조(HES조).CLP후즉각,R조정맥수주유산납림격씨액30 ml/kg 1 h;R+HES조의차정맥수주유산납림격씨액20 ml/kg 40 min화6%간을기정분10 ml/kg 20 min;HES조정맥수주6%간을기정분30 ml/kg 1 h.우CLP후즉각、0.5、1、2、4、8 h(T1～6)시기록MAP.우T6시취경총동맥혈양,측정혈장IL-6화IL-10적농도.결과 여T1시비교,CLP조T4～6시MAP강저,R조T5.6시MAP강저(P＜0.05),기여각조차이무통계학의의(P＞0.05).여S조비교,CLP조MAP강저,혈장IL-6농도승고,IL-10농도강저,R조MAP강저,혈장IL-6농도승고,HES조혈장IL-10농도승고(P＜0.05).여CLP조비교,R+HES조화HES조혈장IL-6농도강저,IL-10농도승고,R조혈장IL-10농도승고(P＜0.05).결론 신생토감염성휴극조기정맥수주유산납림격씨액여6%간을기정분(2∶1)치료,유리우유지촉염세포인자화억염세포인자적평형,종이감경전신염성반응,기효과우우단독정맥수주유산납림격씨액혹6%간을기정분.
Objective To evaluate the effects of treatment with different fluids on systemic inflammatory response in newborn rabbits with septic shock. Methods One hundred New Zealand white rabbits (3-5 days, 45-70 kg) were randomly divided into 5 groups (n = 20 each):group Ⅰ sham operation (group S); group Ⅱ sepsis (group CLP); group Ⅲ lactated Ringer's solution (group R); group Ⅳ 6% HES (group HES) and group V (group R+ HES). The animals were anesthetized with intraperitoneal ketamine and midazolam. Sepsis was induced by cecal ligation and puncture (CLP). The animals in group R and HES received lactated Ringer's solution and 6% hydroxyethyl starch (HES) 30 ml/kg infused iv over 1 h respectively immediately after CLP,while group R+ HES received Ringer's solution 20 ml/kg and 6% HES 10 ml/kg. Nio fluid was infused in groups S and CLP. Carotid artery and jugular vein were cannulated for MAP monitoring, blood sampling and drug and fluid administration. MAP was recorded immediately (T1) and at 0.5, 1, 2, 4, 8 h (T2-6) after CLP. Arterial blood samples were collected at T6 for determination of plasma IL-6 and IL-10 concentrations. Results Compared with those at T1, MAP decreased significantly after CLP at T4-6 in group CLP and at T5.6 in group R but hypotension did not develop after CLP in group HES and R + HES. Plasma IL-6 concentration was significantly higher in group CLP and R than in group S. There was no significant difference in plasma IL-6 concentration between group S and group HES and R + HES. Plasma IL-10 concentration was significantly lower in group CLP and higher in group HES than in group S. There was no significant difference in plasma IL-10 concentration between group S and group R and R + HES. Plasma IL-6 concentration was significantly lower, while plasma IL-10 concentration was significantly higher in group R + HES and HES,and plasma IL-10 concentration was significantly higher in group R or6% HES infused iv alone in maintaining the balance between pro-and anti-inflammatory cytolines in newborn rabbits with septic shock.
