中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
14期
6481-6486
,共6页
陈明富%仲兵%何绍明%刘英娜%张干
陳明富%仲兵%何紹明%劉英娜%張榦
진명부%중병%하소명%류영나%장간
休克,出血性%复苏术%垂体激素类,后叶
休剋,齣血性%複囌術%垂體激素類,後葉
휴극,출혈성%복소술%수체격소류,후협
Shock,hemorrhagic%Resuscitation%Pituitary hormones,posterior
目的：比较重度未控制性失血性休克（UHS）早期延迟复苏、低压液体复苏和垂体后叶素复苏的效果。方法犬24只，采用股动脉穿刺放血使平均动脉压降至50 mm Hg，随机分为三组（n=8）：延迟复苏组（A组）不采用任何复苏措施，低压液体复苏组（B组）静脉输注羟乙基淀粉（HES200/0.5）、垂体后叶素组（C组）每次静注垂体后叶素0.1～0.4 U/kg，使MAP≥50 mm Hg，1 h后全部停止放血行充分容量复苏。监测放血前即刻（T0）、达到目标血压时（T1）、实施三种复苏方法后1 h（T2）、复苏平稳后2 h（T3）各时点的血流动力学指标及动脉血气参数，同时采血样本检测TNF-α和IL-10。观察实验犬出血量、存活率并取死亡或存活超过72 h立即处死后的心肌、肺、肾组织进行病理学检查。结果（1）血流动力学指标：在T2时点，A组的SBP、DBP、MAP、CVP、HR明显低于B组和C组（P<0.05），且大多数动物（6/8）死亡。（2）炎症介质及动脉血气参数：T1和 T2时点，三组的碱缺失（BD）、血乳酸（BL）和 SvO2均与T0有明显差别（P<0.01）；在T3时点，三组的BD和BL仍处在T1和T2之间，但SvO2恢复正常。三组TNF-α和IL-10的变化规律与BD和BL一致，但在T2和T3时点，A组与B、C两组之间有统计学差异（P<0.05）。（3）出血量及成活率：在未控制性失血期，A组的失血量少于B和C组，但仅与B组有统计学差异（P<0.05）。A组72 h的成活率为25%，明显低于B组的87.5%和C组的100%（P<0.01）。（4）病理学检查：A组心、肺、肾病理损害程度都明显重于B、C两组，但C组的损害程度略轻于B组。结论在重度UHS条件下，垂体后叶素和低压液体复苏均为早期有效的复苏方式，两者复苏后的存活率均高且无统计学差异；但低压复苏组的失血和组织损伤程度比垂体后叶素组明显，复苏质量不如后者。延迟复苏不适宜用于重度UHS。
目的：比較重度未控製性失血性休剋（UHS）早期延遲複囌、低壓液體複囌和垂體後葉素複囌的效果。方法犬24隻，採用股動脈穿刺放血使平均動脈壓降至50 mm Hg，隨機分為三組（n=8）：延遲複囌組（A組）不採用任何複囌措施，低壓液體複囌組（B組）靜脈輸註羥乙基澱粉（HES200/0.5）、垂體後葉素組（C組）每次靜註垂體後葉素0.1～0.4 U/kg，使MAP≥50 mm Hg，1 h後全部停止放血行充分容量複囌。鑑測放血前即刻（T0）、達到目標血壓時（T1）、實施三種複囌方法後1 h（T2）、複囌平穩後2 h（T3）各時點的血流動力學指標及動脈血氣參數，同時採血樣本檢測TNF-α和IL-10。觀察實驗犬齣血量、存活率併取死亡或存活超過72 h立即處死後的心肌、肺、腎組織進行病理學檢查。結果（1）血流動力學指標：在T2時點，A組的SBP、DBP、MAP、CVP、HR明顯低于B組和C組（P<0.05），且大多數動物（6/8）死亡。（2）炎癥介質及動脈血氣參數：T1和 T2時點，三組的堿缺失（BD）、血乳痠（BL）和 SvO2均與T0有明顯差彆（P<0.01）；在T3時點，三組的BD和BL仍處在T1和T2之間，但SvO2恢複正常。三組TNF-α和IL-10的變化規律與BD和BL一緻，但在T2和T3時點，A組與B、C兩組之間有統計學差異（P<0.05）。（3）齣血量及成活率：在未控製性失血期，A組的失血量少于B和C組，但僅與B組有統計學差異（P<0.05）。A組72 h的成活率為25%，明顯低于B組的87.5%和C組的100%（P<0.01）。（4）病理學檢查：A組心、肺、腎病理損害程度都明顯重于B、C兩組，但C組的損害程度略輕于B組。結論在重度UHS條件下，垂體後葉素和低壓液體複囌均為早期有效的複囌方式，兩者複囌後的存活率均高且無統計學差異；但低壓複囌組的失血和組織損傷程度比垂體後葉素組明顯，複囌質量不如後者。延遲複囌不適宜用于重度UHS。
목적：비교중도미공제성실혈성휴극（UHS）조기연지복소、저압액체복소화수체후협소복소적효과。방법견24지，채용고동맥천자방혈사평균동맥압강지50 mm Hg，수궤분위삼조（n=8）：연지복소조（A조）불채용임하복소조시，저압액체복소조（B조）정맥수주간을기정분（HES200/0.5）、수체후협소조（C조）매차정주수체후협소0.1～0.4 U/kg，사MAP≥50 mm Hg，1 h후전부정지방혈행충분용량복소。감측방혈전즉각（T0）、체도목표혈압시（T1）、실시삼충복소방법후1 h（T2）、복소평은후2 h（T3）각시점적혈류동역학지표급동맥혈기삼수，동시채혈양본검측TNF-α화IL-10。관찰실험견출혈량、존활솔병취사망혹존활초과72 h립즉처사후적심기、폐、신조직진행병이학검사。결과（1）혈류동역학지표：재T2시점，A조적SBP、DBP、MAP、CVP、HR명현저우B조화C조（P<0.05），차대다수동물（6/8）사망。（2）염증개질급동맥혈기삼수：T1화 T2시점，삼조적감결실（BD）、혈유산（BL）화 SvO2균여T0유명현차별（P<0.01）；재T3시점，삼조적BD화BL잉처재T1화T2지간，단SvO2회복정상。삼조TNF-α화IL-10적변화규률여BD화BL일치，단재T2화T3시점，A조여B、C량조지간유통계학차이（P<0.05）。（3）출혈량급성활솔：재미공제성실혈기，A조적실혈량소우B화C조，단부여B조유통계학차이（P<0.05）。A조72 h적성활솔위25%，명현저우B조적87.5%화C조적100%（P<0.01）。（4）병이학검사：A조심、폐、신병리손해정도도명현중우B、C량조，단C조적손해정도략경우B조。결론재중도UHS조건하，수체후협소화저압액체복소균위조기유효적복소방식，량자복소후적존활솔균고차무통계학차이；단저압복소조적실혈화조직손상정도비수체후협소조명현，복소질량불여후자。연지복소불괄의용우중도UHS。
Objective To compare the effects of delayed resuscitation, hypotensive fluid resuscitation and pituitrin resuscitation on severe uncontrolled hemorrhagic shock(UHS) in dogs at early stage. Methods Severe UHS was produced by exsanguinating hemorrhage from femoral artery in 24 healthy dogs which were randomized into 3 groups(n=8)according to resuscitation strategies after MAP about 50 mm Hg. None resuscitation measure was given in group A(delayed resuscitation), a small quantity of hydroxyethyl starch (HES200/0.5) and pituitrin (0.1-0.4 U/kg) was given via vein in group B and group C respectively to maintain goal blood pressure(50 mm Hg). After 1 h, exsanguination was stopped and full volume resuscitation was given. Hemodynamics index, blood gas analysis, TNF-αand IL-10 were monitored at T0(before exsanguinating), T1(the time for the goal blood pressure achieved), T2(1 h after T1) and T3(2 h after T2). Blood loss and survival to 72 hours were observed. The samples of heart, kidney and lung were taken for pathology test when the dogs died or were killed immediately after 72 h. Results (1)Hemodynamics:Compared with group B and group C, the SBP, DBP, MAP, CVP and HR of group A were significantly lower at T2(P<0.05), and most of the dogs(6/8) died. (2) Inflammatory medium and blood gas analysis:The BD, BL and SvO2 of the three groups were significantly difference from T0 at T1 and T2(P<0.01), but the SvO2 was normal at T3 in spite of the BD and BL were still high. The changes of TNF-αand IL-10 were the same as the BD and BL, but which of group A was significantly difference from group B and group C at T2 and T3(P<0.05). (3) Blood loss and survival rate:During uncontrolled blood loss, blood loss in group A was lower than that of group B(P<0.05), but here was no significant difference between group A and group C. The survival rates of 72 h in group A(25%) was significantly lower than that of group B(87.5%) and group C(100%)(P<0.01). (4)Pathology test: The pathological lesions of heart, kidney and lung in group A were more serious than that of group B and group C, but the lesion of group C was lighter than that of group B. Conclusion On severe uncontrolled hemorrhagic shock, both hypotensive fluid resuscitation and pituitrin resuscitation are effective at early stage, but the blood loss and organizational lesion of hypotensive fluid resuscitation are significantly more serious than that of pituitrin resuscitation, and delayed resuscitation is inadvisable.
