连续性静-静脉血液滤过对内毒素休克羊血流动力学的影响

Effects of continuous veno-venous hemofiltration on the hemodynamics of sheep with endotoxic shock

目的 探讨连续性静静脉血液滤过( CVVH)对内毒素休克血流动力学的影响及作用机制,并观察其对内毒素休克预后的影响。方法 利用大肠杆菌内毒素( L 2 880 )诱导绵羊内毒素休克模型,随机分为对照组( NHF)和治疗组( HF)两组,观察CVVH(零平衡,40 ml·kg-1·h-1超滤,血流速80 ml/ min)对内毒素休克羊血流动力学的影响。结果 内毒素注入后两组实验动物平均动脉压( MAP)明显下降;平均肺动脉压( MPAP)、心脏指数( CI)显著升高( P<0 .0 1或P<0 .0 5)。实施CVVH后,HF组MAP、每搏量( SV)明显上升,显著高于NHF组( P<0 .0 1或P<0 .0 5) ;HF组CI无明显变化,NHF组进行性下降并显著低于HF组( P<0 .0 5) ;两组MPAP差异无显著性( P>0 .0 5) ;血浆乳酸浓度NHF组明显高于HF组。5h后HF组全部存活,NHF组死亡2只。结论 应用大肠杆菌内毒素静脉注射可成功制备羊内毒素休克模型;CVVH具有改善内毒素休克血流动力学和预后的作用,是治疗内毒素休克的重要手段。

Objective To study the influence of continuous venovenous hemofiltration (CVVH) on the hemodynamics and the prognosis of sheep with endotoxic shock. Methods Endotoxic shock was induced by intravenous infusion of lipopolysaccharide, L2880, to sheep, and the animals were randomly divided to control group (NHF, endotoxin only) or treatment group (HF, endotoxin+CVVH). In the latter groups a zerobalanced CVVH was instituted with an ultrafiltration rate of 40 ml·kg -1 ·h -1 and a blood flow rate of 80 ml/min. The hemodynamic parameters were monitered. Results After the administration of endotoxin, the mean arterial pressure (MAP) was decreased significantly, while mean pulmonary artery pressure (MPAP) and cardiac index (CI) increased significantly in both groups ( P <0.05 or P <0.01). With CVVH, MAP and stroke volume (SV) were increased significantly, and were significantly higher than that of NHF group ( P <0.05 or P <0.01). CI declined progressively in NHF group and significantly lower than that of HF group, in which there was no significant change( P <0.05). No significant difference in MPAP was found between two groups( P >0.05). Moreover, plasma lactate levels were lower in NHF group than in HF group ( P <0.05). After 5 hours, the sheep in HF group all survived, and 2 sheep of NHF group died. Conclusion Intraveous infusion of endotoxin could produce endotoxic shock in sheep. CVVH was shown to have a beneficial effect on the hemodynamics, and it gave a better prognosis in endotoxic, indicating that it might be important method to treat endotoxic shock.