不同容量平衡盐液对初进高原失血性休克犬全身氧代谢及胃肠氧合功能的影响

Influence of different volumes of fluid resuscitation on systemic oxygen metabolism and gastrointestinal oxygenation after hemorrhagic shock in dogs first entering high altitude

目的:研究不同容量平衡盐液复苏对初进高原失血性休克犬DO2、VO2及pHi的影响,以评价不同容量平衡盐液的复苏效果。方法:初进高原犬18只,随机分为3组(n=6)。Ⅰ组为单纯休克组,Ⅱ、Ⅲ组分别为输注1.5、3倍失血量的乳酸林格氏液(LR)组。于放血前、放血毕、休克1 h和液体复苏20、60、120 min,测定并计算DO2I、VO2I、O2ER和pHi。结果:DO2I在休克1 h时降至基础值的30%左右,VO2I约为基础值的40%。复苏后DO2I和VO2I显著增加,但复苏2 h时组Ⅲ的DO2I和VO2I值显著低于组Ⅱ(P<0.05)。失血性休克后PgCO2逐渐升高,pHi逐渐降低。复苏20 min时两复苏组PgCO2、pHi已接近休克前值,但复苏60、120 min时两复苏组pHi较休克前显著降低,且以组Ⅲ降低显著(P<0.05)。结论:在改善全身氧输送和内脏血流灌注方面,1.5倍容量平衡盐液复苏明显优于3倍容量复苏。

Objective：To evaluate the effect of fluid resuscitation of different volumes on DO2, VO2 and pHi after hemorrhagic shock in dogs at high altitude. Methods： A total of 18 adult dogs, first transported to the place of 3 780 meters above the sea level, were randomly divided into three groups （n = 6）： group Ⅰ underwent hemorrhagic shock, group Ⅱ and Ⅲ were infused the lactated Ringer＇s solution （LR） with 1.5, 3 fold volume of blood loss respectively after hemorrhagic shock. The DO2I ,VOEI , OEER, pHi and PgCO2 were measured before and after blood letting, 1 h after hemorrhagic shock and 20, 60, 120 min after fluid resuscitation, respectively. Results： To compare with the basic value, DO2I decreased 70% and VO2I decreased 60% at 1 h after the shock. The VO2I and DO2I were significantly increased after fluid resuscitation in group Ⅱ and Ⅲ, but the DO2I and VO2I were significantly lower in group Ⅲ compared with that in group Ⅱ at 2 h after fluid resuscitation （P 〈 0.05 ）. The PgCO2 gradually increased and phi reduced after hemorrhagic shock. PgCO2 and pHi recovered to the value before the shock at 20 min after fluid resuscitation. But the pHi was significantly lower at 60, 120 min after fluid resuscitation in group Ⅱ and Ⅲ compared with the basic value. The pHi was significantly lower in group Ⅲ compared with that in group Ⅱ （ P 〈 0.05 ）. Conclusion： To improve systemic oxygen delivery and visceral perfusion, 1.5 fold volume of fluid resuscitation is better than 3 fold.