不同剂量液体复苏对重度失血性休克兔死亡率及肾功能的影响

Effect of different does of fluid resuscitation on mortality and renal function on early hemorrhagic shock

目的研究不同剂理液体复苏对进行性出血性休克兔死亡率及肾功能的影响。方法采用控制性颈动脉放血法建立进行性出血性休克兔模型，随机分为3组（无补液（对照）组、小剂量组和大剂量组），输注0．9％氯化钠溶液与羟乙基淀粉40氯化钠溶液混合复苏液（体积比2：1）。无补液组不输液，小剂量复苏组按失血量1倍输液，速度参照平均动脉压目标值50～60mmHg调整，大剂量复苏组按失血量2倍输液，速度参照平均动脉压目标值70～80mmHg调整，于休克0、1、2、3、4h分别检测血清肌酐水平、平均动脉压（MAP）并比较4h死亡率及比较肾脏病理切片等情况。结果小剂量组死亡率显著低于无补液组，P〈0．01，与大剂量复苏组相比死亡率差异无统计学意：义，P〉0．05，大剂量组死亡率与对照组相比无统计学意义，P〉0．05；小剂量组肌酐（cr）与对照组、大剂量液体复苏组比较有明显改善，P〈0．05；休克模型形成后个时间段MAP各不相同，P〈0．05；各组肾脏组织损伤程度各异，差别较明显。结论对进行性出血性休克进行限制性液体复苏有利于降低休克早期死亡率；早期进行小剂量液体复苏可以改善。肾功能，更有效的保护脏器功能。

Objective To investigate the effect of limited fluid resuscitation on mortality and renal function in rabbits＇ uncontrolled hemorrhagic shock. Methods The rabbits＇ progressive hemorrhagic model were created by adopting the controlling carotid artery bloodletting method before randomly divided them into 3 groups, non-infusion group （control group）, limited-infusion group and massive-infusion group. The infusion liquid was formulated of 0.9% sodium chloride solution and hydroxyethyl starch mixture 40 sodium chloride solution （volume than 2：1）. Non-infusion group was given no infusion, while the limited-infusion group was given a small doses of the infusion, 100% of the blood loss, and the massiv-infusion group was given a larger doses of the infusion, 200% of the blood loss. The mean arterial pressure, Cr level, kidney pathological section, and comparison of mortality were detected in 0, 1, 2, 3, 4 hours after the shock. Results It reflected a significant lower mortality of the limited-infusion group than the non-infusion group, P 〈0.01; no statistical difference between the limited-infusion group and massive-infusion group, P 〉 0.05, neither between the massive-infusion and non-infusion group, P 〉 0.05. It also reflected MAP, Cr＋ improvement of the limited infusion group than both the massive-infusion group and the non-infusion group, P 〈0.05. Conclusion Limited infusion of fluid resuscitation is considered being effective in reducing mortality in consecutive hemorrhagic shock. The small dose of fluid resuscitation on early state may improve renal function recovery and protect the viscera function.