中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
8期
653-657
,共5页
周仁鸥%王劲%刘江伟%张东%钱若筠%赵涛
週仁鷗%王勁%劉江偉%張東%錢若筠%趙濤
주인구%왕경%류강위%장동%전약균%조도
中暑%沙漠干热环境%血气分析%酸中毒%脱水%呼吸衰竭%电解质紊乱
中暑%沙漠榦熱環境%血氣分析%痠中毒%脫水%呼吸衰竭%電解質紊亂
중서%사막간열배경%혈기분석%산중독%탈수%호흡쇠갈%전해질문란
Heatstroke%Dry-heat environment of desert%Blood gas analysis%Acidosis%Dehydration%Respiratory failure%Electrolyte disturbance
目的：探讨大鼠在沙漠干热环境中暑状态下动脉血气变化特点，为临床救治提供实验依据。方法成年雄性SD大鼠48只，麻醉后按随机数字表法分成沙漠干热环境轻、中、重度中暑组及其相应对照组共6组，每组8只。将大鼠置于模拟沙漠干热环境人工实验舱（温度41℃、湿度10%）内分别滞留约70、110、145 min建立沙漠干热环境轻、中、重度中暑模型；各对照组大鼠置于常温环境中至相应时间点。取各组大鼠腹主动脉血，采用便携式血气分析仪进行血气分析，并检测电解质。结果①轻度中暑组动脉血二氧化碳分压（PaCO2）升高达（45.64±8.19） mmHg（1 mmHg＝0.133 kPa），动脉血氧饱和度（SaO2）下降至0.84±0.08，pH值下降至7.36±0.11，说明该组大鼠存在呼吸性酸碱失衡；中度中暑组细胞外液剩余碱（BEecf）下降至-3.00（1.50）mmol/L、碳酸氢根离子（HCO3-）下降至（19.39±1.89）mmol/L，pH值下降至7.21±0.07，说明该组大鼠出现了代谢性酸碱失衡；重度中暑组各指标逐渐加重，且与轻度和中度中暑组之间比较差异均有统计学意义（PaCO2：F＝6.537、P＝0.006，SaO2：F＝5.174、P＝0.015，pH值：F＝10.736、P＝0.001，BEecf：χ2＝16.021、P＝0.000，HCO3-：F＝5.612，P＝0.011），说明该组大鼠存在明显的呼吸性酸中毒合并代谢性酸中毒，出现了严重的混合型酸碱失衡。②与各自对照组比较，中度中暑组血红蛋白（Hb）明显升高（g/L：15.31±1.84比13.28±0.94，t＝2.791，P＝0.014）；重度中暑组Hb、红细胞比容（HCT）均明显升高〔Hb（g/L）：16.59±2.52比13.42±1.15，t＝3.224，P＝0.006；HCT：（53.50±6.63）%比（45.50±4.47）%，t＝2.828，P＝0.013〕，说明从轻度至重度中暑阶段大鼠脱水程度逐渐加重。③轻度中暑组血钠正常（t＝0.665，P＝0.517），血钾轻度降低（t＝-2.526，P＝0.024）；中度中暑组血钠明显升高（t＝2.162，P＝0.048），血钾明显降低（t＝-5.458，P＝0.000）；重度中暑组血钠明显降低（U＝12.500，P＝0.038），以低钾为主，部分大鼠明显高钾（U＝19.500，P＝0.195）。结论沙漠干热环境下中暑大鼠出现了酸中毒、电解质紊乱、呼吸衰竭、脱水等改变。提示在治疗时，轻度至中度中暑阶段应以纠正呼吸性酸中毒为主，同时防治代谢性酸中毒，警惕脱水及电解质紊乱的发展；中度至重度中暑阶段应在纠正呼吸性酸中毒的同时，积极防治并纠正逐渐加重的代谢性酸中毒、脱水及电解质紊乱。
目的：探討大鼠在沙漠榦熱環境中暑狀態下動脈血氣變化特點，為臨床救治提供實驗依據。方法成年雄性SD大鼠48隻，痳醉後按隨機數字錶法分成沙漠榦熱環境輕、中、重度中暑組及其相應對照組共6組，每組8隻。將大鼠置于模擬沙漠榦熱環境人工實驗艙（溫度41℃、濕度10%）內分彆滯留約70、110、145 min建立沙漠榦熱環境輕、中、重度中暑模型；各對照組大鼠置于常溫環境中至相應時間點。取各組大鼠腹主動脈血，採用便攜式血氣分析儀進行血氣分析，併檢測電解質。結果①輕度中暑組動脈血二氧化碳分壓（PaCO2）升高達（45.64±8.19） mmHg（1 mmHg＝0.133 kPa），動脈血氧飽和度（SaO2）下降至0.84±0.08，pH值下降至7.36±0.11，說明該組大鼠存在呼吸性痠堿失衡；中度中暑組細胞外液剩餘堿（BEecf）下降至-3.00（1.50）mmol/L、碳痠氫根離子（HCO3-）下降至（19.39±1.89）mmol/L，pH值下降至7.21±0.07，說明該組大鼠齣現瞭代謝性痠堿失衡；重度中暑組各指標逐漸加重，且與輕度和中度中暑組之間比較差異均有統計學意義（PaCO2：F＝6.537、P＝0.006，SaO2：F＝5.174、P＝0.015，pH值：F＝10.736、P＝0.001，BEecf：χ2＝16.021、P＝0.000，HCO3-：F＝5.612，P＝0.011），說明該組大鼠存在明顯的呼吸性痠中毒閤併代謝性痠中毒，齣現瞭嚴重的混閤型痠堿失衡。②與各自對照組比較，中度中暑組血紅蛋白（Hb）明顯升高（g/L：15.31±1.84比13.28±0.94，t＝2.791，P＝0.014）；重度中暑組Hb、紅細胞比容（HCT）均明顯升高〔Hb（g/L）：16.59±2.52比13.42±1.15，t＝3.224，P＝0.006；HCT：（53.50±6.63）%比（45.50±4.47）%，t＝2.828，P＝0.013〕，說明從輕度至重度中暑階段大鼠脫水程度逐漸加重。③輕度中暑組血鈉正常（t＝0.665，P＝0.517），血鉀輕度降低（t＝-2.526，P＝0.024）；中度中暑組血鈉明顯升高（t＝2.162，P＝0.048），血鉀明顯降低（t＝-5.458，P＝0.000）；重度中暑組血鈉明顯降低（U＝12.500，P＝0.038），以低鉀為主，部分大鼠明顯高鉀（U＝19.500，P＝0.195）。結論沙漠榦熱環境下中暑大鼠齣現瞭痠中毒、電解質紊亂、呼吸衰竭、脫水等改變。提示在治療時，輕度至中度中暑階段應以糾正呼吸性痠中毒為主，同時防治代謝性痠中毒，警惕脫水及電解質紊亂的髮展；中度至重度中暑階段應在糾正呼吸性痠中毒的同時，積極防治併糾正逐漸加重的代謝性痠中毒、脫水及電解質紊亂。
목적：탐토대서재사막간열배경중서상태하동맥혈기변화특점，위림상구치제공실험의거。방법성년웅성SD대서48지，마취후안수궤수자표법분성사막간열배경경、중、중도중서조급기상응대조조공6조，매조8지。장대서치우모의사막간열배경인공실험창（온도41℃、습도10%）내분별체류약70、110、145 min건립사막간열배경경、중、중도중서모형；각대조조대서치우상온배경중지상응시간점。취각조대서복주동맥혈，채용편휴식혈기분석의진행혈기분석，병검측전해질。결과①경도중서조동맥혈이양화탄분압（PaCO2）승고체（45.64±8.19） mmHg（1 mmHg＝0.133 kPa），동맥혈양포화도（SaO2）하강지0.84±0.08，pH치하강지7.36±0.11，설명해조대서존재호흡성산감실형；중도중서조세포외액잉여감（BEecf）하강지-3.00（1.50）mmol/L、탄산경근리자（HCO3-）하강지（19.39±1.89）mmol/L，pH치하강지7.21±0.07，설명해조대서출현료대사성산감실형；중도중서조각지표축점가중，차여경도화중도중서조지간비교차이균유통계학의의（PaCO2：F＝6.537、P＝0.006，SaO2：F＝5.174、P＝0.015，pH치：F＝10.736、P＝0.001，BEecf：χ2＝16.021、P＝0.000，HCO3-：F＝5.612，P＝0.011），설명해조대서존재명현적호흡성산중독합병대사성산중독，출현료엄중적혼합형산감실형。②여각자대조조비교，중도중서조혈홍단백（Hb）명현승고（g/L：15.31±1.84비13.28±0.94，t＝2.791，P＝0.014）；중도중서조Hb、홍세포비용（HCT）균명현승고〔Hb（g/L）：16.59±2.52비13.42±1.15，t＝3.224，P＝0.006；HCT：（53.50±6.63）%비（45.50±4.47）%，t＝2.828，P＝0.013〕，설명종경도지중도중서계단대서탈수정도축점가중。③경도중서조혈납정상（t＝0.665，P＝0.517），혈갑경도강저（t＝-2.526，P＝0.024）；중도중서조혈납명현승고（t＝2.162，P＝0.048），혈갑명현강저（t＝-5.458，P＝0.000）；중도중서조혈납명현강저（U＝12.500，P＝0.038），이저갑위주，부분대서명현고갑（U＝19.500，P＝0.195）。결론사막간열배경하중서대서출현료산중독、전해질문란、호흡쇠갈、탈수등개변。제시재치료시，경도지중도중서계단응이규정호흡성산중독위주，동시방치대사성산중독，경척탈수급전해질문란적발전；중도지중도중서계단응재규정호흡성산중독적동시，적겁방치병규정축점가중적대사성산중독、탈수급전해질문란。
ObjectiveTo investigate the changes in characteristics of blood gas analysis of heatstroke rats residing in dry-heat environment of desert, and to provide a theoretical reference for its treatment in clinic.Methods Forty-eight male Sprague-Dawley (SD) adult rats under anesthesia were divided into six groups by random number table, with 8 rats in each group: namely mild, moderate, severe heatstroke groups and their corresponding control groups. The rats were placed in an artificial chamber with simulated desert dry-heat environment (temperature 41℃, humidity 10%) for about 70, 110, 145 minutes, respectively, to reproduce mild, moderate, severe heatstroke models. The rats in control groups were placed in a normothermic environment for corresponding duration. Abdominal aorta blood of each group was collected for blood gas analysis, and electrolytes were determined by a portable blood gas analyzer.Results① Arterial partial pressure of carbon dioxide (PaCO2) in mild heatstroke group was increased to (45.64±8.19) mmHg (1 mmHg = 0.133 kPa), arterial oxygen saturation (SaO2) was decreased to 0.84±0.08, pH value was lowered to 7.36±0.11, showing that respiratory acid-base imbalance was resulted. Base excess of extracellular fluid (BEecf) in moderate heatstroke group was decreased to (-3.00±0.76) mmol/L, HCO3- was decreased to (19.39±1.89) mmol/L, and pH value was lowered to 7.21±0.07, indicating that metabolic acid-base imbalance was aggravated gradually. The changes in parameters in severe heatstroke group gradually became more serious, and a significant difference was found as compared with those of mild and moderate heatstroke groups (PaCO2:F = 6.537,P = 0.006; SaO2:F = 5.174,P = 0.015; pH value:F = 10.736,P = 0.001;BEecf:F = 67.136,P = 0.000; HCO3-:F = 5.612,P = 0.011), manifesting an obvious combination of respiratory acidosis and metabolic acidosis, and a serious mixed acid-base disturbance was produced.② Compared with corresponding control groups, hemoglobin (Hb) was significantly increased in moderate heatstroke group (g/L: 15.31±1.84 vs. 13.28±0.94,t = 2.791,P = 0.014), Hb and hematocrit (HCT) in severe heatstroke group were significantly increased [Hb (g/L): 16.59±2.52 vs. 13.42±1.15,t = 3.224,P = 0.006; HCT: (53.50±6.63)% vs. (45.50±4.47)%,t = 2.828, P = 0.013], showing that the degree of dehydration was aggravated gradually from mild to serious degree.③ Serum sodium content in mild heatstroke group was normal (t = 0.665,P = 0.517), serum potassium content was lowered significantly (t = -2.526,P = 0.024); serum sodium content in moderate heatstroke group was increased significantly (t = 2.162,P = 0.048), serum potassium content was lowered significantly (t = -5.458,P = 0.000); and serum sodium content in severe heatstroke group rose obviously (U = 12.500,P = 0.038), and most of the rats showed hypokalemia, with a small proportion of rats showed obvious hyperkalemia (U = 19.500,P = 0.195).ConclusionsAcidosis, electrolyte disturbance, respiratory failure and dehydration in heatstroke occurred in dry-heat environment of desert. It indicates that resuscitation should focus on correction of respiratory acidosis, with simultaneous correction of metabolic acidosis, and one should be alert to correct dehydration and electrolyte disturbance. During the moderate phase and the serious phase, correction of aggravated metabolic acidosis should be reinforced, and the prevention and treatment of the severe dehydration and electrolyte disturbance should be undertaken actively.
