猫失血性休克早期失血量和预后的评估指标

Predictors of blood loss and prognosis during early period of hemorrhagic shock in cat

目的研究失血性休克早期失血量(BV)和预后的评估指标。方法复制猫失血性休克模型,分别按全身血量的20%、30%、40%、50%、60%放血,记录失血前、失血后不同时相点的血压(BP)、心率(HR)和呼吸频率(RR),计算休克指数(SI)和脉压差(DP),测定动脉血气和血乳酸(LA)含量,观察72小时存活率(SR),作相关分析和回归分析。结果常规生理指标中,舒张压(DBP)、平均动脉压(MAP)与BV间在各时相点均呈非常显著负相关(P<0.01),DBP与BV、SR间回归非常显著(P<0.01);LA与BV间呈非常显著正相关(P<0.01),与BV、SR间回归非常显著(P<0.01);动脉血气各指标中,二氧化碳分压(PaCO2)与BV间在各时相点呈非常显著负相关(P<0.01),与BV、SR间在休克即刻、120分钟后回归非常显著(P<0.01)。结论DBP、LA、PaCO2是评估失血性休克早期失血量和预后的良好指标。

Objective To investigate the predictors of bleeding volume and prognosis during early period of hemorrhagic shock. Methods The models of hemorrhagic shock in cats were produced by drawing 20% ,30% ,40% , 50% ,60% of total blood respectively. The blood pressure, heart rate and respiratory rate were measured before bleed- ing and at different time points after hemorrhagic shock. The shock index and pressure difference were calculated. The arterial blood gas and blood lactic acid content were determined. The survival rate within 72 hours was observed. The results were made correlation and regression analysis. Results Among conventional physiological index,diastolic blood pressure（DBP） and mean arterial pressure（MAP） had a significantly negative correlation with bleeding volume at all time points after hemorrhagic shock （ P 〈 0.01 ）. DBP had a significant linear regression relationship with bleeding volume and a logistic regression relationship with survival rate（P 〈 0.01 ）. The lactic acid content had a sig- nificant positive correlation and a linear regression relationship with bleeding volume as well as a logistic regression re- lationship with survival rate（P 〈0.01 ）. Among arterial blood gas index, PaCO2 had a significantly negative correla- tion with bleeding volume and an obvious linear regressoin relationship with blood loss and a logistic regression rela- tionship with survival rate immediately and 120 minutes after hemorrhagic shock（P 〈 0.01 ）. Conclusion DBP, LA and PaCO2 are suitable predictors of blood loss and prognosis during early period of hemorrhagic shock.