复方乳酸钠和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 and Lactate Ringer's solution on the pneumodynamics of toxaemic canine

目的研究复方乳酸钠(LR)或6%羟乙基淀粉溶液(6%HES)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45只,随机均分为三组:对照组(假模型组,C组),腹腔注入生理盐水,无毒血症,用复方乳酸钠30ml/kg作为输注液体;LR组,腹腔注入肠液,毒血症后用复方乳酸钠30ml/kg作为复苏液体;HS组,腹腔注入肠液,毒血症后用6%HES10ml/kg作为复苏液体。于毒血症注药前(T1)及注药后1h(T2)、4h(T3)、8h(T4)测定MAP、心输出量(CO)和肺毛细血管楔压(PCWP)等血流动力学指标。同时记录吸气峰压(PIP)、呼吸肌作功(Wob)、动态顺应性(Cdyn)及无效腔比率(Vd/Vt)等呼吸动力学指标。记录总尿量及体重,计算肺湿/干比。结果 T3、T4时LR、HS组MAP、CO明显低于T1时和C组,T4时HS组MAP、CO明显高于LR组(P<0.05)。T3、T4时LR、HS组PIP、Wob、Vd/Vt明显高于T1时和C组,T4时HS组PIP、Wob明显低于LR组(P<0.05)。HS组肺湿/干比明显低于LR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 investigate the influence of 6% hydroxyethyl starch and Lactate Ringer＇s solution on the pneumodynamics of toxaemic canine. Methods Forty five healthy hybrid canine were randomized into three groups, with fifteen in each. The canine in the control group （group C） were intraperitoneally injected with physiological saline with no toxaemia and then infused with Sodium Lactate Ringer＇s Injection （LR） 30 ml/kg. The canine in group LR were intraperitoneally injected with intestinal juice for fabricating toxaemia and then infused with LR 30 ml/kg. The canine in group HS were intraperitoneally injected with intestinal juice for fabricating toxaemia and then infused with 6% hydroxyethyl starch （HES）. The hemodynamic parameters including mean MAP, HR, cardiac output（CO）, and pulmonary capillary wedge pressure（PCWP） were recorded before （T1） and 1 h （T2）, 4 h （T3）, 8 h （T4） 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 at T3,T4 in groups LR and HS were significantly lower than groups C and at T1 （P〈0.05）. MAP and CO in group HS was significantly higher than the group C at T3 ,T4 （P〈0.05）. PIP, Wob in both groups LR and HS at T3 ,T4 were significantly lower than group C and at T1 basic value and before（P〈0.05）. Vd/Vt in both groups LR and HS were significantly higher than in group C（P〈0. 05）, and Vd/Vt in group HS were significantly lower than group LR（P〈 0.05）. Conclusion 6% hydroxyethyl starch have better performance in hemodynamics and pneumodynamics for toxaemic canine and could effectively protect pneumonic function in fluid resuscitation.