限制性液体复苏孕兔失血性休克对代谢产物变化的影响

Effect of limited volume resuscitation on metabolites in pregnant rabbits with uncontrolled hemorrhagic shock

目的探讨限制性输液复苏孕兔失血性休克对机体代谢终产物的变化的影响。方法建立孕兔失血性休克模型,采取限制性输液(LVR)和传统输液方法(AFR)分别复苏失血性休克孕兔,比较不同组别和不同时间点乳酸(LA)、碱缺失(BD)的变化规律和孕兔的生存情况。结果①急性失血后血浆LA水平成倍增加,非控出血期继续升高,止血控制期逐步下降,LVR组与AFR组比较,第90分钟,P<0.05;第4小时,P<0.01;第8小时LVR组血浆LA水平已完全恢复正常,而AFR组仍高于正常值;②急性失血后血浆BD水平成倍增加,非控出血期继续升高,止血控制期逐步下降,LVR组与AFR组比较,第180分钟,P<0.05;第4小时,P<0.05;第8小时LVR组血浆BD水平已完全恢复正常,而AFR组仍高于正常值;③复苏后24h,AFR组有1例孕兔死亡,LVR组无孕兔死亡;复苏后48h及72h,AFR组有2例孕兔死亡,LVR组有1例孕兔死亡。结论休克发生后,机体代谢产物LA、BD血浆水平均明显升高,限制性输液能增强机体有氧代谢,利于体内LA等代谢产物的清除,同时还改善失血性休克孕兔BD状况,减轻酸中毒反应,增强复苏效果,减少SIRS的发生,提高孕兔生存率。

Objective To Study the effect of limited volume resuscitation（LVR） on metabolites in pregnant rabbit model with uncontrolled hemorrhagic shock.Methods The model of hemorrhagic shock in pregnant rabbit was established. The hemorrhagic shock of pregnant rabbit was resuscitated by two different transfusion methods： LVR and aggressive fluid resuscitation（AFR）. The hemodynamic changes at various time points, the survival rate and the volume of lactate （LA）/ base deficit （BD） were compared between the two groups.Results ① Serum concentration of LA in the two groups were increased obviously after hemorhage, it increased continously in prehospital phase and began to decrease after in hospital. LA at 1.5 h and 4 h in LVR group significant lower than that in AFR group （P〈0.05）. LA in LVR group recovered to normal at 8 h, by that time it still higher than normal in AFR group.② BD levels in all groups were increased continously after hemorrhage and prehospital phase ,it began to decrease in the hospital phase. BD levels at 3 h and 4 h in LVR group significantly lower than that in AFR group（P〈0.05）. BD in LVR group recovered to normal at 8h, and it still slightly higher than normal in AFR group. There was one pregnant rabbit died in AFR Group while no animal died in LVR group within 24 hours after resuscitation. There only one death occurred in LVR group 72 hours after resuscitation, but two death in AFR group.Conclusions Compared with AFR, LVR optimize tissue oxygenation by ameliorate the eliminating of LA and BD, reduce the severity of metabolic acidosis, thus achieve higher survival rate and lower occurrence of SIRS.