中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
9期
693-697
,共5页
倪沁赟%黄焰霞%徐静媛%邱海波
倪沁赟%黃燄霞%徐靜媛%邱海波
예심빈%황염하%서정원%구해파
休克,出血性%复苏术%内脏循环%血液动力学
休剋,齣血性%複囌術%內髒循環%血液動力學
휴극,출혈성%복소술%내장순배%혈액동역학
Shock,hemorrhagic%Resuscitation%Splanchnic circulation%Hemodynamics
目的 观察全血、晶体液及胶体液对急性失血性休克兔肠系膜微循环的影响.方法 利用股动脉放血复制急性失血性休克模型,以平均动脉压(MAP)下降至40 mm Hg并稳定30 min作为模型成功的标准.动物数字法随机分成空白对照组、全血复苏组、林格氏液复苏组和羟乙基淀粉复苏组,每组7只,MAP至少恢复至基础水平的90％时认为液体复苏达标.肠系膜微循环采用旁流暗视野(SDF)成像仪器进行图像采集,通过总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)及微血管血流指数(MFI)对肠系膜微循环进行评价.分别在基础状态时、失血性休克时、复苏达标时(Res-0)和复苏达标30 min时(Res-30)进行数据采集.结果 各组动物一般情况、全身血流动力学及肠系膜微循环在基础状态时无明显差异,在失血性休克时各组动物MAP均在40 mm Hg左右,认为急性失血性休克模型复制成功.与失血性休克时相比,液体复苏可使全血复苏组MAP[(39.6 ±2.4) mm Hg比(69.0±6.1)mm Hg],林格氏液复苏组MAP[(39.6±1.5) mm Hg比(63.9±7.3) mmHg],羟乙基淀粉复苏组MAP[(39.1±2.2)mm Hg比(67.1 ±7.8) mm Hg]在复苏达标时明显升高(均P＜0.05),基本恢复至基础状态时水平.与失血性休克时相比,液体复苏均可使TVD、PVD、PPV和MFI在Res-0时和Res-30时升高,在Res-0时,羟乙基淀粉复苏组TVD(16.1±2.8)比(21.2 ±4.0),PVD(16.0 ±2.8)比(21.2±4.0)显著低于林格氏液复苏组(均P＜0.05),在Res-30时,各组肠系膜微循环指标差异无统计学意义(P＞0.05).结论 急性失血性休克时,早期采用全血及林格氏液复苏可更好地改善肠系膜微循环.
目的 觀察全血、晶體液及膠體液對急性失血性休剋兔腸繫膜微循環的影響.方法 利用股動脈放血複製急性失血性休剋模型,以平均動脈壓(MAP)下降至40 mm Hg併穩定30 min作為模型成功的標準.動物數字法隨機分成空白對照組、全血複囌組、林格氏液複囌組和羥乙基澱粉複囌組,每組7隻,MAP至少恢複至基礎水平的90％時認為液體複囌達標.腸繫膜微循環採用徬流暗視野(SDF)成像儀器進行圖像採集,通過總血管密度(TVD)、灌註血管密度(PVD)、灌註血管比例(PPV)及微血管血流指數(MFI)對腸繫膜微循環進行評價.分彆在基礎狀態時、失血性休剋時、複囌達標時(Res-0)和複囌達標30 min時(Res-30)進行數據採集.結果 各組動物一般情況、全身血流動力學及腸繫膜微循環在基礎狀態時無明顯差異,在失血性休剋時各組動物MAP均在40 mm Hg左右,認為急性失血性休剋模型複製成功.與失血性休剋時相比,液體複囌可使全血複囌組MAP[(39.6 ±2.4) mm Hg比(69.0±6.1)mm Hg],林格氏液複囌組MAP[(39.6±1.5) mm Hg比(63.9±7.3) mmHg],羥乙基澱粉複囌組MAP[(39.1±2.2)mm Hg比(67.1 ±7.8) mm Hg]在複囌達標時明顯升高(均P＜0.05),基本恢複至基礎狀態時水平.與失血性休剋時相比,液體複囌均可使TVD、PVD、PPV和MFI在Res-0時和Res-30時升高,在Res-0時,羥乙基澱粉複囌組TVD(16.1±2.8)比(21.2 ±4.0),PVD(16.0 ±2.8)比(21.2±4.0)顯著低于林格氏液複囌組(均P＜0.05),在Res-30時,各組腸繫膜微循環指標差異無統計學意義(P＞0.05).結論 急性失血性休剋時,早期採用全血及林格氏液複囌可更好地改善腸繫膜微循環.
목적 관찰전혈、정체액급효체액대급성실혈성휴극토장계막미순배적영향.방법 이용고동맥방혈복제급성실혈성휴극모형,이평균동맥압(MAP)하강지40 mm Hg병은정30 min작위모형성공적표준.동물수자법수궤분성공백대조조、전혈복소조、림격씨액복소조화간을기정분복소조,매조7지,MAP지소회복지기출수평적90％시인위액체복소체표.장계막미순배채용방류암시야(SDF)성상의기진행도상채집,통과총혈관밀도(TVD)、관주혈관밀도(PVD)、관주혈관비례(PPV)급미혈관혈류지수(MFI)대장계막미순배진행평개.분별재기출상태시、실혈성휴극시、복소체표시(Res-0)화복소체표30 min시(Res-30)진행수거채집.결과 각조동물일반정황、전신혈류동역학급장계막미순배재기출상태시무명현차이,재실혈성휴극시각조동물MAP균재40 mm Hg좌우,인위급성실혈성휴극모형복제성공.여실혈성휴극시상비,액체복소가사전혈복소조MAP[(39.6 ±2.4) mm Hg비(69.0±6.1)mm Hg],림격씨액복소조MAP[(39.6±1.5) mm Hg비(63.9±7.3) mmHg],간을기정분복소조MAP[(39.1±2.2)mm Hg비(67.1 ±7.8) mm Hg]재복소체표시명현승고(균P＜0.05),기본회복지기출상태시수평.여실혈성휴극시상비,액체복소균가사TVD、PVD、PPV화MFI재Res-0시화Res-30시승고,재Res-0시,간을기정분복소조TVD(16.1±2.8)비(21.2 ±4.0),PVD(16.0 ±2.8)비(21.2±4.0)현저저우림격씨액복소조(균P＜0.05),재Res-30시,각조장계막미순배지표차이무통계학의의(P＞0.05).결론 급성실혈성휴극시,조기채용전혈급림격씨액복소가경호지개선장계막미순배.
Objective To explore the effects of blood,crystalloid and colloid on mesenteric microcirculation in rabbits of acute hemorrhagic shock.Methods Hemorrhagic shock was induced in 28anesthetized mechanically ventilated rabbits by withdrawing blood to a mean arterial blood pressure (MAP) of 40 mm Hg and maintained for 30 min.The animals were randomized into blank control group,whole blood resuscitation group,Ringer's solution resuscitation (RR) group and volume resuscitation (VR) group (n =7 each).The data of vital signs,systemic hemodynamic parameters,arterial blood gas analysis and mesenteric microcirculation were collected at baseline,hemorrhagic shock (HS-0),resuscitation 0 min (Res-0) and resuscitation 30 min (Res-30).And side-stream dark field imaging (SDF) was employed to acquire the images of mesenteric microcirculation.Results No significant difference existed in the basic status between 4 groups.MAP decreased to around 40 mm Hg in all groups.MAP increased significantly after active fluid resuscitation (P ＜ 0.05).In addition to blank control group,total vascular density (TVD),perfused vessel density (PVD),proportion of perfused vessels (PPV) and microvascular flow index (MFI)significantly increased after active fluid resuscitation in the other three groups.TVD and PVD were significantly lower at Res-0 in VR than in RR (P ＜ 0.05).Conclusion After acute hemorrhagic shock,fluid resuscitation with whole blood and Ringer's solution improves systemic hemodynamics.And the combined regimen of whole blood and Ringer's solution is better at restoring mesenteric microcirculation.
