两种液体复苏方案对创伤后非控制性失血性休克家兔血流动力学的影响

Effects of two methods of fluid resuscitation on hemodynamic in uncontrolled hemorrhagic shock in traumatic rabbits

目的:建立非控制性失血性休克的家兔模型,研究两种不同复苏方案对家兔血流动力学的影响。方法:24只家兔复制成非控制性失血性休克模型,随即分成四组,假手术组(SHAM组)、休克未治疗组(SWT组)、积极性复苏组(PT组)、限制性复苏组(LT组)。在实验设定的时间段内,采用两种复苏方案输入的液体有:7.5%高渗氯化钠溶液(7.5%Hypertonic saline,HTS),乳酸林格氏液(Lactated Ringer's solution,LRS),羟乙基淀粉溶液(Hydroxyethyl Starch 130/0.4,HES)。在实验的0min、30min、60min、90min,监测家兔的左心室压力上升或下降的最大速率(the maximal change rate of left intraventricular pressure,±dp/dtmax)以及左心室收缩压(1eft intraventricular systolic pressure,LVSP),并在90min实验结束时,处死家兔,统计出血量,补液量。结果:在监测指标±dp/dtmax和LVSP上,PT组和LT组分别与SWT组比较时,60min、90min的指标均有统计学意义(P<0.05);60min时,PT组与LT组相比较,各指标数值虽略大,但差异无统计学意义(P>0.05);90min时,PT组与LT组相比较各项指标均有统计学意义(P<0.05)。补体量上,30-60min、60-90min两个阶段,PT组与LT组比较所用LRS、HES的量均有统计学意义(P<0.05);失血量上,PT组分别与LT组、SWT组比较后,均有统计学意义(P<0.05),LT组与SWT组比较无统计学意义(P>0.05)。结论:在非控制性失血性休克的早期救治中,采用限制性液体复苏方案较积极性液体复苏,补液量少,并且对家兔心功能的维持作用效果比较明显;尤其在控制活动性失血上,与积极性复苏相比,限制性复苏优势明显。

Objective：To establish the model of uncontrolled hemorrhagic shock in traumatic rabbits,we studied the effects of two methods of fluid resuscitation on hemodynamic in Rabbits.Methods：24 rabbits were duplicated the model of uncontrolled hemorrhagic shock,and distributed into 4 groups randomizedly,which included：Sham group,SWT group（shock without treatment）,PT group（posi-tive treatment）,LT group（limited treatment）.We infused the fluid-7.5% Hypertonic saline（HTS）,Lactated Ringer＇s solution（LRS）,Hy-droxyethyl Starch 130/0.4（HES）-via two methods of fluid resuscitation at designed time.We detected the target,including the maxi-mal change rate of left intraventricular pressure（±dp/dtmax） and 1eft intraventricular systolic pressure（LVSP）,at the point of 0min,30min,60min,90min.Then we executed the rabbit at the end of experiment,and reckoned the total blood loss and infused fluid.Results：Compared with SWT group respectively,the data of ±dp/dtmax and LVSP in PT group and LT group had statistical signifi-cance at the point of 60min,90min（P0.05）.Compared with LT group,the data of PT group was little more than it in LT group,never-theless,the comparison had no statistical significance at the point of 60min（P0.05）;but at the point of 90min,every index had statistical significance between the two group（P0.05）.PT group used LRS and HES significantly more than them in LT group（P0.05）at the phase of 30-60min、60-90min about the infused fluid.Compared with SWT and PT group respectively,PT group had more total blood loss significantly（P0.05）,but the total blood loss had obviously no statistical significance between PT and SWT group（P0.05）.Conclusions：At the first aid of uncontrolled hemorrhagic shock,limited fluid resuscitation used little fluid,and took more important part in myocardium function obviously in rabbits compared with positive fluid resuscitation.Especially,limited fluid resuscitation had more advantage than positive fluid resuscitation on controlling active blood loss.