快速补液对门静脉血波动力学的影响

THE EFFECT OF RAPlD INFUSION TO PORTAL HEMODYNIMICS OF CIRRHOTIC CANINES AFTER HEMORRHAGIC SHOCK

目的：探讨急性失血性休克（ＨＳ），对肝硬化门静脉高压犬门静脉系统血流动力学，和快速补液对门静脉压力等指标恢复的影响。方法：肝硬化门脉高压犬模型造成急性ＨＳ，并于ＨＳ后给予快速补液（１０００ｍｌ／ｈ）抗休克，插管直接测定门静脉压力（ＰＶＰ）、平均动力脉压（ＭＡＰ），肝脏血流量（ＨＢＦ）。连续观察补液９０分钟内门静脉血液动力学变化。结果：显示ＨＳ后ＰＶＰ及ＨＢＦ明显下降，在给予快速静脉补液后ＭＡＰ、ＰＶＰ、ＨＢＦ可快速回升。随着继续补液ＰＶＰ和ＨＢＦ进一步升高，并超过原水平（Ｐ值＜０．０５）。ＰＶＰ和ＨＢＦ达到ＨＳ前水平时的补液量大约为失血量６０％。结论：肝硬化ＨＳ后，快速补液后ＰＶＰ会早于ＭＡＰ迅速升高并超过休克前水平，ＰＶＰ达到正常水平时所需补液量明显小于失血量。

Aim: This study examines hemodynamics of portal veins of hepatic cirrhosis dogs after hemorrhagic shock (HS ) and the effects of fast fluid infusion to portal hemodynamics after HS and resus- citation. Methods:Cirrhotic canine models with portal hypertension were assigned to HS. After shock the canines were given fast fluid infusion( 1000ml/hr). portal vein preaure(PVP) . mean arterial pressure (MAP) . hepatic blood flow (HBF) and hepatic vein pressure (HVP) were monitored continuosly during shock and resuscitation for 90 micts. Results: The study indicate PVP and HBF reduced significantly in HS, and rise again rapidly after fast fluid infusion. Then HBF and PVP can rise more than the normal level (P<0.05 ) with continuous infusion. Giving about 60% of hemorrhage volume fluid could raise PVP to normal level. Conclusion: PVP and HBF can rise to normal level rapidly even more than the normal level by fast fluid infusion after HS . The volume of fluid infusion which forces the PVP to mormal level was obviously less than hemorrhaged volume.