不同液体复苏条件下多巴酚丁胺对肠缺血-再灌注休克的疗效比较

Comparison of dobutamine under different fluids resuscitation for shock induced by intestinal ischemia/reperfusion injury

目的 比较多巴酚丁胺在不同液体复苏条件下对兔肠缺血再灌注损伤 (I/ R)所致休克的治疗效果。方法 32只新西兰白兔随机分为乳酸林格液 (L RS)复苏组、L RS+羟乙基淀粉溶液 (HES)复苏组、L RS复苏 +多巴酚丁胺治疗组 (L RS+DOB组 )和 L RS+HES复苏 +多巴酚丁胺治疗组 (L RS+HES+DOB组 )。采用肠系膜上动脉夹闭 6 0 m in后松夹行再灌注制备肠 I/ R休克模型 ,松夹再灌注时同步进行液体复苏和多巴酚丁胺治疗。观察各时间点血流动力学参数 (平均动脉压、心率、心排血量、肠系膜上动脉血流 )的变化 ,并通过测定动脉二氧化碳间隙〔 Pt a CO2 间隙 =肠黏膜 CO2 分压 (Pt CO2 ) -动脉血 CO2 分压 (Pa CO2 )〕、肠黏膜 p H值 (p Hi)、动脉血乳酸浓度和氧输送 (DO2 )等指标间接评价组织氧合情况。结果 多巴酚丁胺能显著减轻兔肠I/ R休克后平均动脉压、心率、心排血量和肠系膜上动脉血流的下降 ,两多巴酚丁胺治疗组与两复苏组比较 ,差异均有显著性 (P均 <0 .0 5 ) ;且 L RS+HES+DOB组平均动脉压下降程度较 L RS+DOB组明显减轻 (P<0 .0 5 )。与 L RS组比较 ,两多巴酚丁胺治疗组均能明显降低血乳酸浓度和 Pt a CO2 间隙 ,升高 p Hi和 DO2 (P均<0 .0 5 ) ,尤其在 L RS+HES+DOB组效果更显著 (P均 <0 .0 5 ) ,与 L

Objective To compare the effects of dobutamine under different fluids resuscitation for shock induced by intestinal ischemia/reperfusion (I/R) injury in rabbits. Methods Thirtytwo anesthetized rabbits were randomized into four groups of eight animals each. The groups were followed as: ①lactated Ringer's solution(LRS) resuscitation; ②LRS+hydroxyethyl starch solution(HES) resuscitation; ③LRS resuscitation+dobutamine treatment; ④LRS+HES resuscitation+dobutamine treatment. All these rabbits underwent the intestinal I/R injury developed by occluding superior mesenteric artery (SMA) with a noncrushing vascular clamp for 60 minutes and then loosing the clamp for 300 minutes. The fluid resuscitation and drug treatment began at the same time of reperfusion. Hemodynamic parameters including mean artery pressure (MAP), heart rate (HR), aortic velocity (AoV, as cardiac output) and SMA blood flow (Qsma) were measured. Tissue oxygenation was assessed indirectly by measuring the tonometric parameters of the gut, including difference between partial pressure of carbon dioxide in intestinal intramucosal and partial pressure of carbon dioxide in arterial blood (PtaCO 2 gap), intestinal intramucosal pH (pHi), arterial blood lactate acid concentration and oxygen delivery (DO 2). Results HR, AoV and Qsma as measured in two dobutamine groups were significantly higher in values than LRS and LRS+HES groups (all P <0 05). But MAP as measured in two dobutamine groups were significantly higher in values than only LRS ( P <0 05), and in LRS+HES resuscitation+dobutamine treatment group was also significantly higher in values than LRS resuscitation+dobutamine treatment group ( P <0 05). Dobutamine in LRS resuscitation+dobutamine treatment and LRS+HES resuscitation+dobutamine treatment group could greatly decrease lactate and PtaCO 2 gap, significantly improve pHi and DO 2 compared with other two resuscitation groups (all P <0 05). Dobutamine in LRS+HES resuscitation+dobutamine treatment group could also greatly decrease lactate and PtaCO 2 gap, significantly improve pHi compared with LRS resuscitation+dobutamine treatment group (all P <0 05). Conclusion Dobutamine could improve hemodynamic parameters and tissue oxygenation in shock induced by intestinal I/R injury in rabbits, being better used under the LRS+HES resuscitation.