中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
6期
733-738
,共6页
休克,出血性%垂体激素类,后叶%盐水,高渗%羟乙基淀粉%补液疗法
休剋,齣血性%垂體激素類,後葉%鹽水,高滲%羥乙基澱粉%補液療法
휴극,출혈성%수체격소류,후협%염수,고삼%간을기정분%보액요법
Shock,hemorrhagic%Pituitary hormones,posterior%Saline solution,hypertonic%Hetastarch%Fluid therapy
目的 比较垂体后叶素复苏、高渗盐水复苏和胶体液复苏用于重度非控制性失血性休克(UHS)犬的早期复苏效果.方法 成年中华田园犬,雌雄不拘,体重10～ 12 kg,采用肠系膜动脉分支切断+股动脉穿刺放血法制备重度UHS模型.取重度UHS犬24只,采用随机数字表法,将其分为3组(n=8):血管加压素复苏组(P组):静脉注射垂体后叶素负荷量0.1U,继之以0.04 U·kg-1 ·min-1的速率静脉输注,间断追加0.1 U；高渗盐水复苏组(SA组):单次注射静脉输注7.5％高渗氯化钠注射液6 ml/kg;胶体液复苏组(HES组):静脉输注200/0.5羟乙基淀粉溶液,输注速率18 ～ 38 ml· kg-1·h-1,各组均维持MAP不低于50 mm Hg.各组复苏1h后结扎肠系膜动脉分支彻底止血,充分容量复苏.1h后结扎止血行充分容量复苏.于模型制备前(T0)、模型制备成功即刻(T1)、复苏15 min(T2)、30 min(T3)、45 min(T4)、60 min(T5)以及结扎肠系膜动脉并充分容量复苏2 h(T6)时记录血流动力学指标；T0、T1、T5和T6时取动脉血样,行血气分析；T0、T5、T6及拔除导管后3d采集静脉血样,采用双抗体夹心ABC-ELISA法,测定血清TNF-α、IL-10及促肾上腺皮质醇激素(ACTH)的浓度,计算TNF-α/IL-10比值.记录结扎肠系膜动脉并充分容量复苏后72 h内动物的生存情况.记录UHS模型制备期间(急性创伤失血期)和非控制性出血复苏期的出血量.结果 与P组比较,SA组SBP、DBP、CVP、HR升高,Hct降低,血清IL-10浓度降低,TNF-α浓度、TNF-α/IL-10比值升高,HES组SBP、HR和Lac升高,血清IL-10浓度降低,TNF-α和ACTH浓度、TNF-α/IL-10比值升高(P＜0.05或0.01)；与SA组比较,HES组SBP、DBP、CVP、HR降低,Lac升高,血清IL-10浓度降低,TNF-α和ACTH浓度、TNF-α/IL-10比值升高(P＜0.05).SA组非控制性失血期失血量明显多于P组和HES组(P＜0.05),P组和HES组非控制性失血期失血量比较差异无统计学意义(P＞0.05).3组动物生存率比较差异均无统计学意义(P＞0.05).结论 持续静脉输注小剂量垂体后叶素复苏能更好地维持血压平稳,抑制应激反应和炎性反应,出血相对较少,对于重度UHS犬的复苏效果优于高渗盐水复苏及胶体液复苏.
目的 比較垂體後葉素複囌、高滲鹽水複囌和膠體液複囌用于重度非控製性失血性休剋(UHS)犬的早期複囌效果.方法 成年中華田園犬,雌雄不拘,體重10～ 12 kg,採用腸繫膜動脈分支切斷+股動脈穿刺放血法製備重度UHS模型.取重度UHS犬24隻,採用隨機數字錶法,將其分為3組(n=8):血管加壓素複囌組(P組):靜脈註射垂體後葉素負荷量0.1U,繼之以0.04 U·kg-1 ·min-1的速率靜脈輸註,間斷追加0.1 U；高滲鹽水複囌組(SA組):單次註射靜脈輸註7.5％高滲氯化鈉註射液6 ml/kg;膠體液複囌組(HES組):靜脈輸註200/0.5羥乙基澱粉溶液,輸註速率18 ～ 38 ml· kg-1·h-1,各組均維持MAP不低于50 mm Hg.各組複囌1h後結扎腸繫膜動脈分支徹底止血,充分容量複囌.1h後結扎止血行充分容量複囌.于模型製備前(T0)、模型製備成功即刻(T1)、複囌15 min(T2)、30 min(T3)、45 min(T4)、60 min(T5)以及結扎腸繫膜動脈併充分容量複囌2 h(T6)時記錄血流動力學指標；T0、T1、T5和T6時取動脈血樣,行血氣分析；T0、T5、T6及拔除導管後3d採集靜脈血樣,採用雙抗體夾心ABC-ELISA法,測定血清TNF-α、IL-10及促腎上腺皮質醇激素(ACTH)的濃度,計算TNF-α/IL-10比值.記錄結扎腸繫膜動脈併充分容量複囌後72 h內動物的生存情況.記錄UHS模型製備期間(急性創傷失血期)和非控製性齣血複囌期的齣血量.結果 與P組比較,SA組SBP、DBP、CVP、HR升高,Hct降低,血清IL-10濃度降低,TNF-α濃度、TNF-α/IL-10比值升高,HES組SBP、HR和Lac升高,血清IL-10濃度降低,TNF-α和ACTH濃度、TNF-α/IL-10比值升高(P＜0.05或0.01)；與SA組比較,HES組SBP、DBP、CVP、HR降低,Lac升高,血清IL-10濃度降低,TNF-α和ACTH濃度、TNF-α/IL-10比值升高(P＜0.05).SA組非控製性失血期失血量明顯多于P組和HES組(P＜0.05),P組和HES組非控製性失血期失血量比較差異無統計學意義(P＞0.05).3組動物生存率比較差異均無統計學意義(P＞0.05).結論 持續靜脈輸註小劑量垂體後葉素複囌能更好地維持血壓平穩,抑製應激反應和炎性反應,齣血相對較少,對于重度UHS犬的複囌效果優于高滲鹽水複囌及膠體液複囌.
목적 비교수체후협소복소、고삼염수복소화효체액복소용우중도비공제성실혈성휴극(UHS)견적조기복소효과.방법 성년중화전완견,자웅불구,체중10～ 12 kg,채용장계막동맥분지절단+고동맥천자방혈법제비중도UHS모형.취중도UHS견24지,채용수궤수자표법,장기분위3조(n=8):혈관가압소복소조(P조):정맥주사수체후협소부하량0.1U,계지이0.04 U·kg-1 ·min-1적속솔정맥수주,간단추가0.1 U；고삼염수복소조(SA조):단차주사정맥수주7.5％고삼록화납주사액6 ml/kg;효체액복소조(HES조):정맥수주200/0.5간을기정분용액,수주속솔18 ～ 38 ml· kg-1·h-1,각조균유지MAP불저우50 mm Hg.각조복소1h후결찰장계막동맥분지철저지혈,충분용량복소.1h후결찰지혈행충분용량복소.우모형제비전(T0)、모형제비성공즉각(T1)、복소15 min(T2)、30 min(T3)、45 min(T4)、60 min(T5)이급결찰장계막동맥병충분용량복소2 h(T6)시기록혈류동역학지표；T0、T1、T5화T6시취동맥혈양,행혈기분석；T0、T5、T6급발제도관후3d채집정맥혈양,채용쌍항체협심ABC-ELISA법,측정혈청TNF-α、IL-10급촉신상선피질순격소(ACTH)적농도,계산TNF-α/IL-10비치.기록결찰장계막동맥병충분용량복소후72 h내동물적생존정황.기록UHS모형제비기간(급성창상실혈기)화비공제성출혈복소기적출혈량.결과 여P조비교,SA조SBP、DBP、CVP、HR승고,Hct강저,혈청IL-10농도강저,TNF-α농도、TNF-α/IL-10비치승고,HES조SBP、HR화Lac승고,혈청IL-10농도강저,TNF-α화ACTH농도、TNF-α/IL-10비치승고(P＜0.05혹0.01)；여SA조비교,HES조SBP、DBP、CVP、HR강저,Lac승고,혈청IL-10농도강저,TNF-α화ACTH농도、TNF-α/IL-10비치승고(P＜0.05).SA조비공제성실혈기실혈량명현다우P조화HES조(P＜0.05),P조화HES조비공제성실혈기실혈량비교차이무통계학의의(P＞0.05).3조동물생존솔비교차이균무통계학의의(P＞0.05).결론 지속정맥수주소제량수체후협소복소능경호지유지혈압평은,억제응격반응화염성반응,출혈상대교소,대우중도UHS견적복소효과우우고삼염수복소급효체액복소.
Objective To compare pituitrin resuscitation,hypertonic saline resuscitation versus hydroxyethyl starch (HES) resuscitation during the early stage in a dog model of severe uncontrolled hemorrhagic shock (UHS).Methods Adult Chinese rural dogs of both sexes,weighing 10-12 kg,underwent sever UHS by transecting one branch of mesenteric arteries,followed by blood withdrawal via the femoral artery to target mean arterial pressure (MAP) of 50 mm Hg.Twenty-four dogs with severe UHS were randomized into 3 groups according to resuscitation strategies (n =8 each):pituitrin resuscitation group (group P),hypertonic saline resuscitation group (group SA),and resuscitation with HES (group HES).In group P,pituitrin was infused at a rate of 0.04U· kg-1 · min-1 after a loading dose of 0.1 U was given intermittently.A single bolus of 7.5 ％ hypertonic saline 6 ml/kg was injected in group SA.HES 200/0.5 was infused at a rate of 18-38 ml· kg-1· h-1 in group HES.MAP was maintained no lower than 50 mm Hg in each group.The branch of mesenteric arteries was ligated 1 h after resuscitation and all the blood initially shed was returned in each group.The parameters of hemodynamics were recorded before UHS (T0),after successful UHS (T1),at 15,30,45 and 60 min of resuscitation (T2-5),and at 2 h after hemostasis and return of shed blood (T6).Arterial blood samples were taken at T0,T1,T5 and T6 for blood gas analysis.Venous blood samples were collected at T0,T5,T6 and 3 days after extubation for determination of serum TNF-α,IL-10 and adrenocorticotropic hormone (ACTH) concentrations.TNF-α/IL-10 ratio was calculated.The survival rate was measured within 72 h after hemostasis and return of shed blood.The volume of blood loss was recorded during UHS phase and uncontrolled bleeding resuscitation phase.Results Compared with group P,SBP,DBP,CVP,HR,serum TNF-α concentration and TNF-α/IL-10 ratio were significantly increased,and Hct and serum IL-10 concentration were decreased in group SA,and SBP,HR,Lac,TNF-α and ACTH concentrations,and TNF-α/IL-10 ratio were significantly increased,and serum IL-10 concentration was decreased in group HES (P ＜ 0.05).SBP,DBP,CVP,HR and serum IL-10 concentration were significantly lower,and Lac,TNF-α and ACTH concentrations,and TNF-α/IL-10 ratio were higher in group HES than in group SA (P ＜ 0.05 or 0.01).The volume of blood loss recorded during uncontrolled bleeding resuscitation phase was significantly larger in group SA than in P and HES groups (P ＜ 0.05).There was no significant difference between P and HES groups in the volume of blood loss recorded during uncontrolled bleeding resuscitation phase (P ＞ 0.05).There was no significant difference in the survival rate between the three groups (P ＞ 0.05).Conclusion Resuscitation with continuous infusion of a small dose of pituitrin can maintain the blood pressure stable with less blood loss and inhibit stress responses and inflammatory responses,and the efficacy is superior to that of resuscitation with a small dose of hypertonic saline or HES resuscitation.
