冷液腹腔灌洗抢救热射病休克的实验研究

Experimental study on emergency treatment of shock with cooling solution lavage in heatstroke

目的 探讨热射病休克的抢救方法。方法 将家兔热暴露至休克发生 ,然后将其置于室温下。用传统的冷水浸泡、冷生理盐水 (NSS)腹腔灌洗和冷腹膜透析液 (PDS)腹腔灌洗方法抢救 ,观察动物中心体温的变化和存活时间 ,以及冷PDS腹腔灌洗组中血液K+ 、pH值、尿素氮和肌肝的变化。结果 ①冷水浸泡组 (n =8) ,直肠温度 (Tr)和食道温度 (Te)下降缓慢 ,平均存活 (16 3± 2 5 2 )分钟。②冷NSS腹腔灌洗组 (n =10 )和冷PDS腹腔灌洗组 (n =10 ) ,下丘脑温度 (Tb)、Tr和Te下降迅速 ,血压回升 ,平均存活时间分别为 (83 2± 47 8)、(98 5± 6 7 4)分钟 ,比冷水浸泡组存活时间显著延长。③冷PDS腹腔灌洗组中休克时血K+ 升高 ,酸中毒明显 ,透析 30分钟后得以改善 ,而显著升高的尿素氮和肌酐则改变不明显 ,存活时间比冷NSS腹腔灌洗组延长。结论 冷液腹腔灌洗是抢救热射病休克有效的方法 ,尤其是冷PDS腹腔灌洗 ,为进一步救治赢得了宝贵的时间。

Objective To investigate the rescue method of shock in heatstroke. Methods Expose rabbit to hot condition, and cause shock. Then place it under room temperature. Rescue the rabbit by means of soaking in traditional cold water, peritoneal lavaging with colling normal saline solution (NSS) and colling peritoneal dialysis solution (PDS). The changes of body core temperature, the survival time in every groups and the K + concentration, pH, blood urea nitrogen and creatinine of the arterial blood in cooling PDS peritoneal lavage grou were observed.Results ①In cold water immersion(n=8), the rectal temperature (Tr) and esophageal temperature (Te) decreased slowly, and the mean survival time was 16.3±25.2 min.②In cooling normal saline solution (NSS) peritoneal lavage groups (n=10) and cooling PDS peritoneal lavage group (n=10), Te, Tr and the brain temperature (Tb) decreased promptly and arterial blood pressure increased. The mean survival time was prolonged to 83.2±47.8 min and 98.5±67.4 min.③In PDS peritoneal lavage groups, the K + concentration, creatinine and blood urea nitrogen increased, the pH of the arterial blood decreased and all blood biochemical parameters improved significantly after lavage expect creatinine and blood urea nitrogen. The mean survival time was prolonged compared with cooling NSS peritoneal lavage groups.Conclusion Cooling solution peritoneal lavage is an effective measure to rescue from shock in heatstroke, especially in cooling PDS peritoneal lavage groups, and they are able to win one golden hour for the further treatment of heatstroke. [