琥珀酰明胶对早期急性呼吸窘迫综合征血流动力学及氧合的影响

Effect of fluid therapy with gelofusion on hemodynamics and oxygen metabolism in early acute respiratory distress syndrome

目的观察琥珀酰明胶对早期急性呼吸窘迫综合征（ARDS）患者血流动力学及氧合的影响。方法12只幼猪静脉注射油酸制备ARDS模型后，根据早期目标导向治疗（EGDT）的不同随机给予6h晶体液（A组）或琥珀酰明胶（B组）限制性复苏，比较血流动力学、氧合的变化。结果复苏过程中，B组心输出量（CO）显著升高（P〈0．05）；两组每搏变异度（SVV）先升高后降至13％，B组SVV变化更早（P〈0．05）；两组氧合指数可升至200，组内差异有统计学意义（P〈0．05），组间差异无统计学意义（P〉0．05）。两组胃黏膜pH值〉7．32，B组升高的时间更早。结论琥珀酰明胶有助于血流动力学稳定及组织灌注，但改善肺水肿作用不显著。

Objective To observe the heterogeneous response of hemodynamics and oxygen metabolism of piglets with acute respiratory distress syndrome （ARDS） caused by oleic acid injection to restrictive fluid therapy using colloid or crystalloid. Methods ARDS models were established by oleic acid injection of 12 piglets. The piglets were randomly treated by restrictive fluid therapy for 6 h guided by early goal-directed therapy （EGDT） using crystalloid （group A） or colloid （group B）. The results of hemodynamics and oxygen metabolism were measured at different time points. Results After ARDS models were established, extravascular lung water （EVLW）, lung compliance, and arterial oxygenation index got worsen obviously in both groups. Group A wasted more time to reach the standard of EGDT and needed more liquid than group B. Afer the 6-h fluid therapy, central venous oxygen saturation （ScvO2 ） , intramucosal pH （pHi）, cardiac output （CO） and cardiac index （CI） in group B were higher than in group A. EVLW and arterial oxygenation index exhibited improvement in both groups, but there was no significant difference in EVLW and arterial oxygenation index between two groups. Conclusion Restrictive fluid therapy with colloid can obtain hemodynamic stability, improve oxygenation and reduce pulmonary interstitial edema, and has no difference to restrictive fluid therapy with crystalloid.