高原失血性休克再灌流中肺水肿右心衰竭实验研究

STUDY OF PULMONARY EDEMA AND RIGHT HEART FAILURE OF DOGS WITH HEMORRHAGIC SHOCK DURING RAPID INFUSION AT HIGH ALTITUDE

海拔3658m,当地犬16只,股动脉放血,造成失血性休克,血压维持在5,33kpa,在休克期和输液期中死亡6只为死亡组,另10只随机分成输液组和对照组各5只,输液组在休克后2h内输入所放血液和3倍失血总量的平衡液。对照组仅输入所放血液。三组均测定基础状态、休克期、回输2h,5h的MFAP(股动脉压)、MPAP(肺动脉压)、血浆蛋白、ANP(心钠素)、EDF(内源性洋地黄因子)、PRA(肾素活性)、ALD(醛固酮)、AⅡ(血管紧张素(Ⅱ)、CVP(中心静脉压)等。结果表明,在高原上2h内输入了3倍失血总量的平衡液可以造成犬肺水肿模型。发生肺水肿的机理可能与MPAP升高和血浆蛋白降低有密切关系。而发生右心功能衰竭则与EDF、ANP降低,PRA、AⅡ、CVP升高有关。

16 dogs were got and studied at high altitude (HA, above sea level 3658m). they were bled from the femoral artery to make the hemorrhagic shock and their mean arteral blood pressure remained 5. 33 kPa. Six dogs died during shock phase of 16 were regarded as the death group (DG). The others were divided equally at random into the in fusion group (IG) and the control group (CG) Within two hours of shock, dogs of IG were transfused with themselves bled blood and the equilibration saline whose volume was 3 times as much as that of the bled blood and dogs of CG were only transfused with themselves bled blood. The mean femoral arteral pressure(MFAP), mean pulmonary arteral pressure (MPAP)and the concentration of the plasmic protein, ANP, EDF, PR A, ALD, A I and CVP of three sroups in the bassic state, shock phase and at 2nd and 5th hour after transfusion were measured. It was found that at HA the pulmonary edema could be induced by the tranfusion of 3 times equilibration saline at the 2nd hour. It is indicated that the pulmonary edema during the transfusion related obviously to the HA hypoxia, the increas of MPAP and decrease of plasmic proteins. The right heart failure related to the decrease of EDF, ANP and increase of PRA, A I and CVP.