活动性出血性休克限制性晶体复苏的实验研究

Limited fluid resuscitation in uncontrolled hemorrhagic shock

目的:探讨有活动性出血的失血性休克家兔对不同剂量液体复苏的疗效。方法:用股动脉放血的方法复制活动性出血的休克家兔模型,随机分成5组(n=8),即:不输液对照组(N4组),大剂量液体复苏组(N3组),中剂量液体复苏组(N2组),小剂量液体复苏组(N1组),假手术对照组(N5组)。抽血使各实验组动物平均动脉压降至40mmHg,并维持30min,然后用平衡盐溶液复苏,再观察动物120min或直至动物死亡时,记录各组动物活动性出血量、死亡数、红细胞比容(Hct)、平均动脉压的变化以及肾脏皮质超氧化物歧化酶(SOD)活性。结果:N5组的各项指标均优于N1、N2、N3组(P<0·01);N4组的各项指标均劣于N1、N2、N3组(P<0·01);N3组的出血量、动物死亡数均明显高于N1和N2组(P<0·01)。N3组的SOD均明显低于N1和N2组(P<0·01)。随着复苏液体量的增加,Hct逐渐减小,观察期内N2组、N3组、N4组平均动脉压逐渐下降,死亡数增加。结论:在有活动性出血的失血性休克情况下,应进行限制性补液,止血前仅输少量液体,可以明显减少出血量,降低死亡数,有利于后续治疗。

Objective： To investigate the effect of limited resuscitation in a model of uncontrolled hemorrhagic shock. Methods： Uncontrolled hemorrhagic shock model was established in 40 rabbits. When mean arterial pressure（MAP） was lowered to 40 mmHg and maintained 30 minutes, resuscitation was begun. Ringer＇s solution in fusion was continued as needed to maintain the following desired requirements：Group N4 without resuscitation,Croup N3 with the most fluid, Group N2 with more fluid, Croup N1 with little fluid after shock. Besides, GroupN5 without shock. MAP, the death rate, the blood loss, superoxide dismutase （SOD） , the hematocrit （Hct） of all animals were observed for 210 minutes or until death. Results： MAP,death rate, blood loss, SOD, Hct of Group N5 were better than Croup N1 , N2, N3 （ P 〈 0. 01 ）. MAP, death rate, blood loss and Hct of Group N4 is worse than Croup N1 , N2, N3 （ P 〈 0. 01 ）. The death rate of Croup N4 was the first in all groups. With the increase of fluid in resuscitation,death rate became higher at last and the blood loss became high in resuscitation（ P 〈 0.01 ）. Hct and MAP in Croup N1 were significantly higher than in Group N2, N3, N4 in the end （P 〈0. 01 ）. SOD of Group N1 was the highest in all groups except Group N5 （P 〈 0, 01 ）. Conclusions： Attempts to achieve normal MAP during uncontrolled bleeding will result in more hemorrhage volume and markedly higher mortality. Limited resuscitation before hemostat could significantly reduce death rate and blood loss for the following treatment.