CAJ | 학술논문

目的研究中心静脉血氧饱和度(ScvO2)在失血性休克兔休克复苏过程中作为输血指标与传统输血指标的比较.方法选择新西兰纯系家兔32只,单纯随机分为4组,A、B两组为观察组,C、D两组为对照组,每组8只.A、B、C、D四组分别以ScvO2≤70％、ScvO2≤75％、Hb≤8g/dl、失血量≥30％全血量为输血指征.从右股动脉放血,10min内使MAP降到约(40±5)mmHg,并维持这血压60min,建立失血性休克兔的动物模型.然后开始复苏,胶体液和晶体液基本按1∶2的比例输注,输注速度约为10～15ml/(kg·h),根据血压、心率适当调节,并按照每组的不同要求进行输血.监测基础值、休克时、休克治疗30、60、120、180min各个时间点的各项指标,以及失血量、输血量、输晶体液、胶体液量等.结果 A组在休克治疗观察后期血压、pH、BE、HCO3 -、O2 ER等明显与其它三组差异有统计学意义(P＜0.05),B组与C、D两组同时间点各组监测指标差异无统计学意义(P＞0.05).输血量C组最多,与其它三组比较差异有统计学意义(P＜0.05),D组输血量比A、B两组要多(P＜0.05),A、B两组输胶体液、晶体液量明显多于C、D两组(P＜0.05),各组失血量差异无统计学意义(P＞0.05).结论 ScvO2用于失血性休克兔复苏监测可以指导失血性休克兔的输血,依据ScvO2≤75％输血和传统的输血指标监测,可以达到同样的复苏效果,而且能更精确和个体化指导输血,减少不必要的输血,节约血资源.
목적 연구중심정맥혈양포화도(ScvO2)재실혈성휴극토휴극복소과정중작위수혈지표여전통수혈지표적비교.방법 선택신서란순계가토32지,단순수궤분위4조,A、B량조위관찰조,C、D량조위대조조,매조8지.A、B、C、D사조분별이ScvO2≤70％、ScvO2≤75％、Hb≤8g/dl、실혈량≥30％전혈량위수혈지정.종우고동맥방혈,10min내사MAP강도약(40±5)mmHg,병유지저혈압60min,건립실혈성휴극토적동물모형.연후개시복소,효체액화정체액기본안1∶2적비례수주,수주속도약위10～15ml/(kg·h),근거혈압、심솔괄당조절,병안조매조적불동요구진행수혈.감측기출치、휴극시、휴극치료30、60、120、180min각개시간점적각항지표,이급실혈량、수혈량、수정체액、효체액량등.결과 A조재휴극치료관찰후기혈압、pH、BE、HCO3 -、O2 ER등명현여기타삼조차이유통계학의의(P＜0.05),B조여C、D량조동시간점각조감측지표차이무통계학의의(P＞0.05).수혈량C조최다,여기타삼조비교차이유통계학의의(P＜0.05),D조수혈량비A、B량조요다(P＜0.05),A、B량조수효체액、정체액량명현다우C、D량조(P＜0.05),각조실혈량차이무통계학의의(P＞0.05).결론 ScvO2용우실혈성휴극토복소감측가이지도실혈성휴극토적수혈,의거ScvO2≤75％수혈화전통적수혈지표감측,가이체도동양적복소효과,이차능경정학화개체화지도수혈,감소불필요적수혈,절약혈자원.
Objective To study central venous oxygen saturation (ScyO2) in controlled hemorrhagic shock rabbits resuscitation process as a transfusion trigger and traditional transfusion trigger of comparison.Methods Selection New Zealand pure line of rabbit 32 only,simple randonly divided into 4 groups,groups A and B for the observation group,groups C and D as control group,groups of eight only.A,B,C,D four groups respectively by ScvO2 ≤70％,ScvO2 ≤75％,hemoglobin (Hb)≥8g/dl,blood loss for the whole blood volume≥30％ as transfusion trigger.From right femoral artery bloodletting 10 minute inside,made the MAP to about (40 ± 5 )mmHg,and maintained the blood pressure 60 minutes,established controlled hemorrhagic shock rabbits of animal model.And then started to resuscitate,with colloid and crystalloid infusion according to the proportion 1∶2,infusion rate of about 10 ～ 15ml/( kg · h),according to the blood pressure and heart rate,and proper adjustment according to the different requirements of each group conducted a blood transfusion.Monitoring based value,shock,shock treatment 30 minutes,60 minutes,120 minutes,180 minutes all time points,and various indexes of blood loss,blood transfusions,crystalloid and colloid fluid volume and so on.Results In shock treatment observation group A late blood pressure,pH,BE,HCO3-,O2ER etc compared with the other three groups had obvious statistical differences ( P ＜ 0.05 ),group B with C and D two groups at the same time points each monitoring were no significant differences ( P ＞0.05 ).The volume of transfusion group C was most,compared with the other three groups were significant difference ( P ＜ 0.05 ),group D of blood transfusions than A,B two groups (P ＜ 0.05 ),groups A and B infused colloid fluid,crystal fluid volume than groups C and D ( P ＜ 0.05 ),each group blood lossed without significant difference.Conclusion ScvO2 for controlled hemorrhagic shock rabbit resuscitation monitoring can guide controlled hemorrhagic shock rabbit of blood transfusions,according to ScvO2 ≤75％ transfusion with traditional according to Hb or blood loss transfusion trigger comparison,can achieve the same resuscitation effect,and can more accurately and individualized guide transfusion,reduce unnecessary blood transfusions,save resources.