CAJ | 학술논문

目的：研究液体复苏联合早期血管活性药应用对感染性休克兔组织灌注的影响。方法：采用内毒素注射法制备兔感染性休克模型。48只大白兔随机均分为6组，设注射LPS前（T）、休克时（T0）、休克后30分（T1/2）、1h （T1）、2h（T2）、4h（T4）、6h（T6）共7个时间点，分别监测动物平均动脉压（MAP）、中心静脉压（CVP）、左室压力上升/下降最大速率（±dp/dtmax）变化，并检测动脉血浆中乳酸（LAC）浓度，计算各组6h乳酸清除率。结果：（1）各治疗组均能使MAP或CVP得到提升；休克后1h补液升压同时组MAP上升幅度显著高于其它治疗组（P均<0.05）；T6时升压组、补液后升压组、升压后补液组、补液升压同时组差异无统计学意义（P均>0.05）；补液组、补液后升压组、补液升压同时组的CVP在休克后2小时可恢复到休克前水平，而升压组、升压后补液组的CVP不能；±dp/dtmax在升压组、升压后补液组、补液升压同时组在1/2h、1h、2h均比对照组、补液组、补液后升压组高（P均<0.05），补液升压同时组最高；（2） LAC在治疗1h时开始出现回落，1h、2h时补液组、补液后升压组比升压组、升压后补液组LAC明显降低（P均<0.05），2h、4h、6h时补液升压同时组LAC显著低于其它治疗组（P均<0.05）；（3）各组6小时乳酸清除率，补液升压同时组最高。结论：感染性休克治疗中，液体复苏、升压药独用或联合使用都可提升血压，提高组织灌注压，改善组织灌注与氧代谢，降低血乳酸水平，提高6小时血乳酸清除率。
목적：연구액체복소연합조기혈관활성약응용대감염성휴극토조직관주적영향。방법：채용내독소주사법제비토감염성휴극모형。48지대백토수궤균분위6조，설주사LPS전（T）、휴극시（T0）、휴극후30분（T1/2）、1h （T1）、2h（T2）、4h（T4）、6h（T6）공7개시간점，분별감측동물평균동맥압（MAP）、중심정맥압（CVP）、좌실압력상승/하강최대속솔（±dp/dtmax）변화，병검측동맥혈장중유산（LAC）농도，계산각조6h유산청제솔。결과：（1）각치료조균능사MAP혹CVP득도제승；휴극후1h보액승압동시조MAP상승폭도현저고우기타치료조（P균<0.05）；T6시승압조、보액후승압조、승압후보액조、보액승압동시조차이무통계학의의（P균>0.05）；보액조、보액후승압조、보액승압동시조적CVP재휴극후2소시가회복도휴극전수평，이승압조、승압후보액조적CVP불능；±dp/dtmax재승압조、승압후보액조、보액승압동시조재1/2h、1h、2h균비대조조、보액조、보액후승압조고（P균<0.05），보액승압동시조최고；（2） LAC재치료1h시개시출현회락，1h、2h시보액조、보액후승압조비승압조、승압후보액조LAC명현강저（P균<0.05），2h、4h、6h시보액승압동시조LAC현저저우기타치료조（P균<0.05）；（3）각조6소시유산청제솔，보액승압동시조최고。결론：감염성휴극치료중，액체복소、승압약독용혹연합사용도가제승혈압，제고조직관주압，개선조직관주여양대사，강저혈유산수평，제고6소시혈유산청제솔。
Objective:To evaluate t he changes on concentrations of tissue perfusion after the fluid resuscitation combined with early application of vasopressor in rabbits with septic shock. Methods:Models of rabbits with septic shock were replicated by endotoxin injection. Forty-eight rabbits with septic shock were randomly divided into six groups: the control group, the fluid infusion group, the vasopressor group, the vasopressor after fluid infusion group, the fluid infusion after vasopressor group, and the fluid infusion with vasopressor group. Blood was collected for seven times, before injecting LPS(T), 0h(T0) before septic shock and 1/2h(T1/2), 1h(T1), 2h(T2), 4h(T4), and 6h(T6) after treatment, in order to detect the changes of the mean arterial pressure(MAP), the central venous pressure(CVP), the rising/falling maximum rate of left ventricular pressure (±dp/dtmax) and the concentrations of LAC and calculate 6h blood lactic acid clearance rate of the six groups. Results:(1) MAP or CVP in all the treatment groups could be enhanceed; MAP of fluid infusion in the vasopressor group was significantly higher than that in the other treatment groups at 1h after shock (P all <0.05); at T6 there was no significant difference (P all>0.05)in the vasopressor group, the vasopressor after fluid infusion group and the fluid infusion with vasopressor group; CVP in the fluid infusion group, the vasopressor after fluid infusion group and the fluid infusion with vasopressor group could recover to the preshock level at 2 hours after the shock, while in the vasopressor group and the fluid infusion after vasopressor group could not; ±dp/dtmax were higher in the vasopressor group, the fluid infusion after vasopressor group and the fluid infusion with vasopressor group than in the control group, the fluid infusion group, the vasopressor after fluid infusion group at 1/2h, 1h, 2h (P all> 0.05), and in the fluid infusion with vasopressor group it was the highest;(2) LAC began to reduce at 1h after the treatment, and at 1h and 2h LAC in the fluid infusion group, and the vasopressor after the fluid infusion group was significantly lower (P all<0.05)than in the vasopressor group and the fluid infusion after vasopressor group, and at 2h, 4h and 6h LAC in the fluid infusion with vasopressor group was significantly lower than in the other treatment groups(P all<0.05); (3) In all groups, 6h blood lactic acid clearance rate of fluid infusion with vasopressor group is the highest. Conclusions:In the treatment of septic shock, fluid resuscitation, application of vasopressor alone or in combination can all raise blood pressure, elevate tissue perfusion pressure, improve tissue perfusion and oxygen metabolism, lower blood lactate levels, increase blood lactate clearance rate of 6 hours. In this study, 6 hours of lactic acid after resuscitation as an index , fluid resuscitation combined with early application of vasopressor was the best of the five programs, and vasopressor alone was the worst.