CAJ | 학술논문

目的观察亚低温对感染性休克所致急性肾损伤(AKI)肾功能、全身及肾脏血流动力学的影响.方法将40只健康犬数字表法随机均分为常温非感染组(NTNS) 10只、常温感染组(NTS) 10只、亚低温非感染组(MHNS) 10只和亚低温感染组(MHS) 10只.NTS组和MHS组以0.5ml·kg-1 ·h-1通过股静脉泵入大肠埃希菌(E.coli1×109 cfu/ml)制作高动力循环感染性休克模型.结合血泵装置和低温恒温槽,对MHNS组和MHS组犬实施体外血液冷却使血温维持于(33±1)℃.0、24、48、72 h时点留取股静脉血行肾功能检测.在0～72 h各时点应用连续心输出量监测仪(PiCCO)监测全身血流动力学.在0～72 h各时点应用CDFI测量肾血流动力学.结果 MHS组较NTS组24～72 h各时点心排血量(C0)减少[(3.58 ±0.44) L/min比(4.18±0.60) L/min,P=0.04],体循环阻力(SVR)增大[(2 415±651) dyn·s·cm-5比(1 613±223) dyn·s·cm-5,P=0.01],尿素氮下降[(8.6±1.6) mmol/L比(21.2±4.8) mmol/L,P＜0.01],血肌酐(Scr)下降[(167.6±31.2) μmol/L比(383.8±35.2)μmol/L,P＜0.01],右主肾动脉收缩期峰流速(PSV)减小(P=0.04),阻力指数(RI)增加(P=0.04)心率(HR)下降(P=0.01),动脉收缩压(SBP)上升(P＜0.05).感染性休克犬,CO与PSV呈正相关(r=0.705,P＜0.01),CO与RI呈负相关(r=-0.810,P＜0.01).结论亚低温能够稳定感染性休克犬全身及肾血流动力学,改善肾脏功能.
목적 관찰아저온대감염성휴극소치급성신손상(AKI)신공능、전신급신장혈류동역학적영향.방법 장40지건강견수자표법수궤균분위상온비감염조(NTNS) 10지、상온감염조(NTS) 10지、아저온비감염조(MHNS) 10지화아저온감염조(MHS) 10지.NTS조화MHS조이0.5ml·kg-1 ·h-1통과고정맥빙입대장애희균(E.coli1×109 cfu/ml)제작고동력순배감염성휴극모형.결합혈빙장치화저온항온조,대MHNS조화MHS조견실시체외혈액냉각사혈온유지우(33±1)℃.0、24、48、72 h시점류취고정맥혈행신공능검측.재0～72 h각시점응용련속심수출량감측의(PiCCO)감측전신혈류동역학.재0～72 h각시점응용CDFI측량신혈류동역학.결과 MHS조교NTS조24～72 h각시점심배혈량(C0)감소[(3.58 ±0.44) L/min비(4.18±0.60) L/min,P=0.04],체순배조력(SVR)증대[(2 415±651) dyn·s·cm-5비(1 613±223) dyn·s·cm-5,P=0.01],뇨소담하강[(8.6±1.6) mmol/L비(21.2±4.8) mmol/L,P＜0.01],혈기항(Scr)하강[(167.6±31.2) μmol/L비(383.8±35.2)μmol/L,P＜0.01],우주신동맥수축기봉류속(PSV)감소(P=0.04),조력지수(RI)증가(P=0.04)심솔(HR)하강(P=0.01),동맥수축압(SBP)상승(P＜0.05).감염성휴극견,CO여PSV정정상관(r=0.705,P＜0.01),CO여RI정부상관(r=-0.810,P＜0.01).결론 아저온능구은정감염성휴극견전신급신혈류동역학,개선신장공능.
Objectives To explore the effects of mild hypothemia on hemodynamics of systemic and renal of dog with septic shock.Methods 40 healthy dogs were randomly and evenly divided into the normal temperature non-infected group (NTNS), normal temperature infected group (NTS), hypothermia noninfected group (MHNS) and hypothermia infected group (MHS).NTS and MHS were pumped through the femoral vein of Escherichia coli (E.coli 1 × 109 cfu/ml) by 0.5 ml · kg-1 · h-1 , producting septic shock model with high-power cycle.Combining with blood pump devices and low temperature thermostat bath, the MHNS and MHS implemented extracorporeal blood cooling method to maintain the blood in temperature (33 ± 1) ℃.0, 24, 48, 72 h point, tested specimens from femoral vein for renal function.In the 0-72 h.Pulse indicates the continuous cardiac output monitor (PiCCO) monitored systemic hemodynamics on each time point.In the 0-72 h, color Doppler ultrasound (CDFI) measured renal hemodynamic on each time point.Results There was an increase of SBP (P ＜0.05), SVR [(2 415 ±651) dyn · s · cm-5vs (1 613 ± 223) dyn · s · cm-5 ,p =0.01] and RI (P =0.04) in the M HS group comparing with the NTS group from 24 to 72 h.CO [(3.58 ±0.44) L/min vs (4.18 ±0.60) L/min,P =0.04], HR and PSV was decreased in the MHS group.BUN [(8.6 ± 1.6) mmol/L vs (21.2 ±4.8) mmol/L,P ＜0.01] and Scr [(167.6 ±31.2) μmol/L vs (383.8 ±35.2) μmol/L,P ＜0.01] was decreased in MHS group comparing with the NTS group.There was a positively correlation between CO and PSV in the canine model of septic shock (P ＜0.01);and CO was negatively correlated with RI (P ＜ 0.01).Conclusions In this canine model of septic shock, hypothermia can stable systemic and renal hemodynamics, and improve kidney function.