6%羟乙基淀粉对毒血症犬呼吸动力学的影响

The Influence of 6% Hydroxyethyl Starch on the Pneumodynamics of the Toxaemic Canine

目的探讨6%羟乙基淀粉溶液(6%HES)进行液体复苏对毒血症犬呼吸动力学的影响。方法健康杂种犬15只,随机分为3组:对照组(n=5)即假模型组,腹腔只注入生理盐水,没有毒血症,用乳酸林格溶液(LR)作为输注液体;LR组(n=5)腹腔注入肠液,毒血症后用LR作为复苏液体;HS组(n=5)腹腔注入肠液,毒血症后用6%HES作为复苏液体。在毒血症前及后0.5、1、4、8h测定犬的平均动脉压(MAP)、心输出量(CO)等血流动力学指标。同时记录吸气峰压(PIP)、呼吸机作功(Wob)、动态顺应性(Cdyn)及无效腔比率(Vd/Vt)等呼吸动力学指标值。记录总尿量及体质量,计算肺湿/干比。结果 MAP、CO在毒血症诱导后4h较基础值明显下降,毒血症诱导后8h下降更为明显,其中HS组MAP、CO明显高于其他组(P<0.05)。毒血症诱导后4、8h,PIP、Wob、Cdyn明显大于基础值,HS组PIP、Wob明显小于其他组(P<0.05);肺湿/干比HS组明显小于LR组(P<0.05);Vd/Vt明显增大,HS组明显小于其他组(P<0.05)。结论 6%HES更有利于毒血症犬血流动力学维持,保护了肺功能。

Objective To explore the influence of 6% hydroxyethyl starch on the pneumodynamics of the toxaemic canine.Methods Fifteen healthy hybrid canine were randomized into three groups,with five in each.The canine in the control group was intraperitoneally injected with nomal salt with no toxaemia and then infused with sodium lactate Ringer＇s injection.The canine in the group of LR was intraperitoneally injected with intestinal juice for fabricating toxaemia and then infused with LR.The canine in the group of HS was intraperitoneally injected with intestinal juice for fabricating toxaemia and then infused with 6% hydroxyethyl starch.The hemodynamic parameters including mean arterial pressure（MAP）,heart rate（HR）,cardiac output（CO）,central venous pressure（CVP） and pulmonary capillary wedge pressure（PCWP） were recorded before and 0.5,1,4,8 h after fabricating toxaemia.The pneumodynamic parameters including peak inspiratory pressure（PIP）,work of breath（Wob）,dynamic compliance（Cdyn） and the ratio of dead space to tidal capacity（Vd /Vt） were also recorded.The body weight（BW） and urine volume（UV） were also recorded for calculating pneumonic wet/dry ratio.Results MAP and CO 4,8h after fabricating toxaemia were significantly lower than the basic value in both groups of LR and HS（P〈0. 05）.MAP and CO in the group of HS was significantly higher than that in the control group and the group of LR 4,8 h fabricating toxaemia（P〈0.05）.PIP,Wob,Cdyn 4,8 h after fabricating toxaemia were significantly higher than the basic value in both groups of LR and HS（P〈0. 05）.Vd/Vtin both groups of LR and HS were significantly higher than that in the control group（P〈0. 05）,and Vd/Vtin the group of HS were significantly lower than that in the group of LR（P〈0. 05）.Conclusion Six percents hydroxyethyl starch exhibits better hemodynamics and pneumodynamics for toxaemic canine and can effectively protect pneumonic function in fluid management.