中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2010年
5期
309-312,后插2
,共5页
谢菲%侯克东%宋青%江朝光
謝菲%侯剋東%宋青%江朝光
사비%후극동%송청%강조광
休克,失血性%骨髓%输液%高渗盐液
休剋,失血性%骨髓%輸液%高滲鹽液
휴극,실혈성%골수%수액%고삼염액
Shock%Hemorrage%Bone marrow%Infusion%Hypertonic saline-hydroxyethyl starch
目的 观察不同复苏液经骨髓腔通路复苏失血性休克后骨髓细胞学及病理学改变.方法 按随机数字表法将18只犬均分为假手术组、生理盐水组、高渗盐溶液组[即7.5%氯化钠-6%羟乙基淀粉40溶液(HSH)组].生理盐水和HSH组动物建立犬失血性休克模型,经胫骨骨髓腔快速(5 min内)按4 ml/kg分别推注生理盐水或HSH进行复苏;假手术组动物不进行放血和输液处理.于复苏前后取外周静脉血和骨髓液计数CD34+阳性率,骨髓涂片染色进行细胞分类及病理观察.结果 复苏后48 h,HSH组静脉血及骨髓液CD34+阳性率均高于生理盐水组(静脉血:(6.915±1.178)%比(4.848±0.527)%,骨髓液:(7.900±0.648)%比(6.875±0.403)%,均P<0.053.复苏后1周,与假手术组相比,生理盐水组红细胞系、粒细胞系细胞比例均显著升高(红细胞系:0.289±0.016比0.253±0.014,粒细胞系:0.615±0.019比0.560±0.013,均P<0.05),淋巴细胞系细胞比例显著下降(O.049±0.007比0.132±0.015,P<0.05);HSH组红细胞系(0.273±0.012)和淋巴细胞系比例(0.162±0.014)均显著升高(均P<0.05),而粒细胞系比例(0.517±0.038)显著下降(P<0.05).生理盐水组和HSH组4周后骨髓各造血细胞系恢复至正常;骨髓病理观察表明输液后骨髓改变轻微,未见坏死细胞.结论 经骨髓腔通路输注小剂量HSH复苏失血性休克犬后,骨髓改变轻微,是一种安全、有效的复苏方案.
目的 觀察不同複囌液經骨髓腔通路複囌失血性休剋後骨髓細胞學及病理學改變.方法 按隨機數字錶法將18隻犬均分為假手術組、生理鹽水組、高滲鹽溶液組[即7.5%氯化鈉-6%羥乙基澱粉40溶液(HSH)組].生理鹽水和HSH組動物建立犬失血性休剋模型,經脛骨骨髓腔快速(5 min內)按4 ml/kg分彆推註生理鹽水或HSH進行複囌;假手術組動物不進行放血和輸液處理.于複囌前後取外週靜脈血和骨髓液計數CD34+暘性率,骨髓塗片染色進行細胞分類及病理觀察.結果 複囌後48 h,HSH組靜脈血及骨髓液CD34+暘性率均高于生理鹽水組(靜脈血:(6.915±1.178)%比(4.848±0.527)%,骨髓液:(7.900±0.648)%比(6.875±0.403)%,均P<0.053.複囌後1週,與假手術組相比,生理鹽水組紅細胞繫、粒細胞繫細胞比例均顯著升高(紅細胞繫:0.289±0.016比0.253±0.014,粒細胞繫:0.615±0.019比0.560±0.013,均P<0.05),淋巴細胞繫細胞比例顯著下降(O.049±0.007比0.132±0.015,P<0.05);HSH組紅細胞繫(0.273±0.012)和淋巴細胞繫比例(0.162±0.014)均顯著升高(均P<0.05),而粒細胞繫比例(0.517±0.038)顯著下降(P<0.05).生理鹽水組和HSH組4週後骨髓各造血細胞繫恢複至正常;骨髓病理觀察錶明輸液後骨髓改變輕微,未見壞死細胞.結論 經骨髓腔通路輸註小劑量HSH複囌失血性休剋犬後,骨髓改變輕微,是一種安全、有效的複囌方案.
목적 관찰불동복소액경골수강통로복소실혈성휴극후골수세포학급병이학개변.방법 안수궤수자표법장18지견균분위가수술조、생리염수조、고삼염용액조[즉7.5%록화납-6%간을기정분40용액(HSH)조].생리염수화HSH조동물건립견실혈성휴극모형,경경골골수강쾌속(5 min내)안4 ml/kg분별추주생리염수혹HSH진행복소;가수술조동물불진행방혈화수액처리.우복소전후취외주정맥혈화골수액계수CD34+양성솔,골수도편염색진행세포분류급병리관찰.결과 복소후48 h,HSH조정맥혈급골수액CD34+양성솔균고우생리염수조(정맥혈:(6.915±1.178)%비(4.848±0.527)%,골수액:(7.900±0.648)%비(6.875±0.403)%,균P<0.053.복소후1주,여가수술조상비,생리염수조홍세포계、립세포계세포비례균현저승고(홍세포계:0.289±0.016비0.253±0.014,립세포계:0.615±0.019비0.560±0.013,균P<0.05),림파세포계세포비례현저하강(O.049±0.007비0.132±0.015,P<0.05);HSH조홍세포계(0.273±0.012)화림파세포계비례(0.162±0.014)균현저승고(균P<0.05),이립세포계비례(0.517±0.038)현저하강(P<0.05).생리염수조화HSH조4주후골수각조혈세포계회복지정상;골수병리관찰표명수액후골수개변경미,미견배사세포.결론 경골수강통로수주소제량HSH복소실혈성휴극견후,골수개변경미,시일충안전、유효적복소방안.
Objective To observe the change in bone marrow after intraosseous hypertonic salinehydroxyethyl starch (HSH) in dogs with hemorrhagic shock.Methods Eighteen male dogs were randomly divided into sham group, normal saline (NS) group (0.9% sodium chloride) and HSH group (7.5% sodium chloride-6% hydroxyethyl starch).Wiggers graded controlled hemorrhagic shock model was reproduced in NS and HSH groups, and above solutions were injected into bone marrow of the tibia in low dosage (4 ml/kg)rapidly (within 5 minutes).The sham group did not lose blood or receive infusion.CD34+ expression of peripheral blood and bone marrow, and the change in picture of different hematopoietic series in bone marrow were examined before and after bone marrow resuscitation.Pathological change in bone marrow was examined after different resuscitation fluid infusion.Results After 48 hours of resuscitation, the percentage of CD34+ in bone marrow and peripheral blood in HSH group were significantly higher than that of NS group [peripheral blood: (6.915 ± 1.178)% vs.(4.848 ± 0.527)%, bone marrow: (7.900 ± 0.648)% vs.(6.875±0.403)%, both P<0.05].One week after resuscitation, the erythrocyte count and granulocytic count in NS group were significantly increased compared with sham group (erythrocyte count: 0.289± 0.016 vs.0.253±0.014, granulocytic count: 0.615±0.019 vs.0.560±0.013, both P<0.05], lymphocytic count was significantly decreased (0.049±0.007 vs.0.132±0.015, P<0.05).In the HSH group, erythrocyte count (0.273±0.012), lymphocytic count (0.162±0.014) were all significantly increased (both P<0.05),while granulocytic count (0.517± 0.038) was significantly decreased (P< 0.05).After 4 week of resuscitation, the change in hemopoiesis series in NS group and HSH group recovered to normal level.The bone marrow morphology changed slightly, and no bone necrosis occurred.Conclusion HSH in small amout through intraosseous space is safe and effective as a fluid resuscitation measure for shock, and little change in bone marrow has been found after the infusion.
