CAJ | 학술논문

目的探讨口服补液对致死性失血性休克犬血液动力学和微循环灌注的影响.方法成年雄性Beagle犬20只,按全身血容量的40%放血制作致死性失血性休克模型.随机分为3组:不补液组(NR组,n=8)、口服补液组(OR组,n=6)和静脉补液组(IR组,n=6).失血后24 h内NR组无治疗,OR组和IR组于制模完成后即刻分别经胃管或静脉输入3倍失血量的葡萄糖-电解质溶液.失血后24 h开始各组动物均实施静脉补液,输入2倍失血量的乳酸钠林格氏液、葡萄糖盐水和复合氨基酸补充生理消耗量.于失血前(T0,基础状态)、失血后2h(T1)、4 h(T2)、8h(T3)、24 h(T4)、48 h(T5)和72 h(T6)时在非麻醉状态下测定MAP、全身血管阻力(SVR)、心指数(CI)、左心室内压最大变化速率(dp,dtmax)、及小肠粘膜血流量(IMBF),并记录犬尿量及失血后72 h内死亡情况.结果 NR组、OR组和IR组病死率分别为63%、33%和0,3组间比较差异有统计学意义(P<0.05).与T0时比较,NR组T1-6时、OR组T1-5时、IR组T1-4时MAP、CI和dp/dtmax降低,3组失血后各时点SVR增高,IMBF降低(P<0.05),IR组和OR组T6时MAP、CI和dp/dtmax差异无统计学意义(P>0.05).与NR组比较,OR组和IR组MAP、CI、dp/dtmax 和IMBF升高,SVR降低,尿量增多(P<0.05);与IR组比较,OR组MAP、CI、dp/dtmax和IMBF降低,SVR升高,尿量降低(P<0.05).结论大致死性失血性休克后24 h内口服3倍失血量的葡萄糖-电解质溶液能显著改善血液动力学和机体微循环灌注,从而改善机体的生存状态,具有显著的复苏效果.
목적 탐토구복보액대치사성실혈성휴극견혈액동역학화미순배관주적영향.방법 성년웅성Beagle견20지,안전신혈용량적40%방혈제작치사성실혈성휴극모형.수궤분위3조:불보액조(NR조,n=8)、구복보액조(OR조,n=6)화정맥보액조(IR조,n=6).실혈후24 h내NR조무치료,OR조화IR조우제모완성후즉각분별경위관혹정맥수입3배실혈량적포도당-전해질용액.실혈후24 h개시각조동물균실시정맥보액,수입2배실혈량적유산납림격씨액、포도당염수화복합안기산보충생리소모량.우실혈전(T0,기출상태)、실혈후2h(T1)、4 h(T2)、8h(T3)、24 h(T4)、48 h(T5)화72 h(T6)시재비마취상태하측정MAP、전신혈관조력(SVR)、심지수(CI)、좌심실내압최대변화속솔(dp,dtmax)、급소장점막혈류량(IMBF),병기록견뇨량급실혈후72 h내사망정황.결과 NR조、OR조화IR조병사솔분별위63%、33%화0,3조간비교차이유통계학의의(P<0.05).여T0시비교,NR조T1-6시、OR조T1-5시、IR조T1-4시MAP、CI화dp/dtmax강저,3조실혈후각시점SVR증고,IMBF강저(P<0.05),IR조화OR조T6시MAP、CI화dp/dtmax차이무통계학의의(P>0.05).여NR조비교,OR조화IR조MAP、CI、dp/dtmax 화IMBF승고,SVR강저,뇨량증다(P<0.05);여IR조비교,OR조MAP、CI、dp/dtmax화IMBF강저,SVR승고,뇨량강저(P<0.05).결론 대치사성실혈성휴극후24 h내구복3배실혈량적포도당-전해질용액능현저개선혈액동역학화궤체미순배관주,종이개선궤체적생존상태,구유현저적복소효과.
Objective To investigate the effect of oral rehydration on hemedynamies and mierocirculatory perfusion in dogs with fatal hemorrhagic shock.Methods Twenty male Beagle dogs 16-20 months old weighing 8-12 ks were subjected to a loss of 40% of the total blood volume,then divided into 3 groups:no rehydration group (group NR,n=8),oral rehydration group(group OR,n=6)and intravenous rehydration group(group IR,n=6).Group NR received no treatment within 24 h after blood-letting.Group IR and OR were given glucose-electrolyte solution (GES) either by gastric tube or by intravenous infusion 3 times volume of the blood loss immediately after the establishment of the model.Then the lactated Ringer's solution,glucose saline and compound amino acid(2 times volume of the blood loss)were started to be given to supplement the physiological consumption from 24 h after blood-letting in each group.The MAP,cardiac index(CI),systemic vascular resistance (SVR),dp/dtmax,and intestinal mucoflal blood flow (IMBF) were determined before blood-letting(T0,baseline) and 2 h (T1),4 h(T2),8 h(T3),24 h(T4),48 h(T5) and 72 h(T6)after blood-letting.The fatality rate within 72 h after blood-letting and urinary output were calculated.Results The fatality rates were 63%,33%and O in group NR, OR and IR respectively, which showed significant difference between the groups (P < 0.05).Compared with the baseline values at To, MAP, CI and dp/dtmax were significantly decreased at T1-6, in group NR,at T1-5 in group OR and at T1-4 in group IR, and SVR was significantly increased, while IMBF decreased at each time point after blood-letting in the three groups ( P <0.05), but no significant change was found in MAP, CI and dp/dtmax at T6 in group IR and OR (P>0.05). MAP, CI, dp/dtmax , IMBF and urinary output were significantly higher, while SVR was significantly lower in group OR and IR than in group NR ( P < 0.05). MAP, CI,dp/dtmax, IMBF and urinary output were signiflcandy lower, while SVR was significantly higher in group OR than in group IR ( P < 0. 05). Conclusion Oral administration of GES 3 times volume of the blood loss within 24 h after fatal hemorrhagic shock can obviously improve the hemodynamics and microcirculatory perfusion, then improve the survival state and have obvious resuscitation efficacy.