不同液体对脓毒性休克大鼠早期复苏效果比较

Comparison of Early Stage Effect of Different Resuscitative Fluids in Rat Models with Septic Shock

目的比较不同液体对脓毒性休克的早期复苏效果。方法成年雄性SD大鼠72只随机分为9组。(1)正常对照组(n=8);(2)脓毒性休克组(n=8):通过颈外静脉注射内毒素(10 mg.kg-1)建立脓毒性休克大鼠模型,不予任何干预;(3)干预组[n=56,又分为7个亚组,每组8只:9 g.L-1盐水(NS)组、低分子右旋糖酐组、清蛋白组、NS+低分子右旋糖酐组、NS+清蛋白组、低分子右旋糖酐+清蛋白组及NS+低分子右旋糖酐+清蛋白混合组(混合组)]:颈外静脉注射内毒素建立模型成功后分别予不同的液体进行复苏。各干预组液体复苏均以1 h为终点,实时监测大鼠平均动脉压(MAP),当MAP恢复至基础血压90%以上,并持续10 min或以上视为复苏成功,记录其复苏成功所需时间。至1 h时通过颈外静脉置管采中心静脉血1 mL行血气分析及血乳酸水平测定。比较各干预组大鼠复苏成功率、所需时间、血气指标及血乳酸变化。结果复苏成功率及所用时间:NS组、NS+清蛋白组、NS+低分子右旋糖酐组及混合组的复苏成功率均大于50%,其中以NS组和混合组复苏成功率最高,分别为87.50%和83.33%,4组比较差异无统计学意义(F=1.136,P>0.05);而低分子右旋糖酐组、清蛋白组及低分子右旋糖酐+清蛋白组复苏效果较差(成功率小于50%),其中以纯胶体液清蛋白和低分子右旋糖酐效果最差,其复苏成功率分别为16.67%和25.00%,与NS组比较差异有统计学意义(P<0.05)。各组复苏成功所需的平均时间比较,NS组需要的平均时间最短[(18.50±8.85)min],其次为NS+清蛋白组、混合组及NS+低分子右旋糖酐组,4组比较差异无统计学意义(F=1.519,P>0.05);而低分子右旋糖酐组、清蛋白组及低分子右旋糖酐+清蛋白组复苏所需的时间相对较长,3组间比较差异无统计学意义(F=1.018,P>0.05),与NS组比较差异均有统计学意义(Pa<0.05),各组血气分析pH值与休克组相比,清蛋白组和低分子右旋糖酐+清蛋白组均改善较明显(P<0.05);NS组和NS+清蛋白组在提高氧分压及乳酸水平方面与休克组比较差异有统计学意义(P<0.05)。结论大鼠休克早期存在酸碱平衡紊乱;从复苏成功率、复苏所需时间、改善氧分压及降低血乳酸水平方面,NS及NS联合清蛋白优于其他晶胶组合液及胶体液。

Objective To compare the effects of different fluids for early resuscitation in septic shock. Methods Seventy - two adult male SD rats were divided into 9 groups. （ 1 ） normal group （ n = 8 ） ; （ 2 ） septic shock group （ rt = 8 ） ; （ 3 ） intervention groups （ n = 56） ： they were divided into 7 subgroups ： normal saline group, dextran group, albumin group, saline with dextran group, saline with albumin group, dextran with albumin group and mixture group. Septic shock models were made by injecting endotoxin（ 10 mg · kg^-1 ） via external jugular vein and then given different fluids. The end point was 1 hour after the resuscitation. Successful resuscitation was defined as that the mean arterial pressure （MAP） recovered to 90% of the basic blood pressure. The MAP was monitored for real time and recorded the time for resuscitation. Blood gas analysis and lactate levels were measured by testing central venous blood. These indexes were compared among different groups. Results The success rates of normal saline group,saline with dextran group, saline with albumin group and mixture group were more than 50% , while the saline group（87.50% ） and the mixture group（ 83.33% ） were the highest. There were no significant differences among these 4 groups（ F = 1.136, P 〉 0.05 ）. But the effects of dextran group, albumin group and dextran with albumin group were worse, the albumin group and dextran group were the worst,their success rates were 16.67% and 25.00%. There was significant difference between these 2 groups and the saline group （ P 〈 0.05 ）. For the average resuscitation time, the saline group was the shortest [ （ 18.50± 8.85 ） min ], fallowed with saline with albumin group, mixture group and normal saline with dextran group. There were no significant differences among these 4 groups （F = 1.519, P 〉 0. 05 ）. But the resuscitation time of dextran group, albumin group and dextran with albumin group were longer than others. There were no significant differences among these 3 groups （ F = 1. 018, P 〉 0.05 ） , but there was significant difference between these 3 groups and normal saline group（ P 〈0.05 ）. Blood gas analysis in each group compared with the septic shock group, pH value was significantly improved in albumin group and dextran with albumin group ; the partial pressure of oxygen improved and the lactate levels decreased in saline group and normal saline with albumin group to compare with septic shock group（ P 〈 0.05 ）. Conclusions Disturbance of acid - base balance occur in the early stage of shock. The effect of normal saline and saline with albumin group were better than erystalloid with colloid fluids and colloid fluid in the success rate of resuscitation, resuscitation time, improvement of partial pressure of oxygen and reduction of lactate levels.