干热环境创伤失血性休克猪钾离子变化特点

The features of serum K^＋ variation in swine with traumatic hemorrhagic shock within the dry-heat environment

目的 观察沙漠干热环境创伤失血性休克（THS）猪血清钾离子（K^＋）、乳酸（Lac）、葡萄糖（Glu）的变化特点及其可能机制。方法 本地长白仔猪40头随机（随机数字法）分为4组：常温假手术组（NS）、常温创伤失血性休克组（NTHS）、干热假手术组（DS组）、干热创伤失血性休克组（DTHS），每组10只。4组均在“西北特殊环境人工实验舱”各自相应环境[（干热环境：气温 （40.5±0.5）℃，湿度 （10±2）%；常温环境：气温 （25±0.5）℃，湿度 （35±5）%）］暴露3 h后，NS组和DS组仅行剖腹术，NTHS组和DTHS组在剖腹术后行部分肝脏及全脾切除，继而自髂外动脉快速放血致平均动脉压（MAP）降至（45±5） mmHg,成功建立创伤失血性休克模型。分别于暴露后、休克模型成功时（0 h）及以后每30 min自髂外动脉抽取血液样本，检测血清K^＋、Lac、Glu水平，观察各组不同时间点各项指标的变化，应用单因素方差分析和Pearson相关性分析进行统计学处理。结果 暴露3 h后干热环境组血清K^＋浓度高于常温组（P〈0.01），Glu浓度低于常温组（P〈0.01）。DTHS 组从模型建立到动物死亡（约3 h），血清K^＋和Lac浓度均呈进行性快速增高，而NTHS组血清K^＋和Lac浓度均呈缓慢性增高，两组血清K^＋与Lac相关系数分别是rDHTS=0.927（P〈0.01），rNTHS=0.539（P〈0.01）；DTHS组Glu浓度进行性下降，NTHS组未见明显变化，两组K^＋与Glu呈负相关，相关系数分别是rDHTS= -0.804（P〈0.01），rNTHS= -0.420（P〈0.01）。结论 干热环境下的创伤失血性休克血清K^＋、Lac、Glu变化早且快，在相同的时间点较常温环境创伤失血性休克明显， K^＋的升高与Lac升高呈正相关，与Glu变化呈负相关，提示干热环境创伤失血性休克的救治更要注意纠正高钾血症和酸中毒，并注意防范低血糖的发生。

Objective To observe the changes of potassium ion （K^＋）, lactic acid （Lac） and glucose （Glu） in swine with traumatic hemorrhagic shock （THS） inside the dry-heat environment and to explore its possible mechanism. Methods A total of 40 local Landrace piglets were randomly（random number） divided equally into 4 groups： the normal temperature sham operation group （NS）, the normal temperature traumatic hemorrhagic shock group （NTHS）, the dry-heat sham operation group （DS group） and the dry-heat traumatic hemorrhagic shock group （DTHS）. The experiment was carried out in the artificia climate cabin simulated the special environment of northwest of China. After exposed to their respective environment[dry-heat environment： （40.5±0.5）, plus（10±2）% humidity; normal temoerature environment： （25±0.5）, plus（35±5）% humidity] for 3 h. Laparotomy were performed in swine of all groups, and then splenectomy and partial hepatectomy were performed only in NTHS and DTHS. The process of exsanguination from the external iliac artery was established to make the MAP reaching to 40-50 mmHg, and thus the traumatic hemorrhagic shock model of swine was successfully made. Blood samples were collected from external iliac artery at different intervals including the time just after exposure for 3 h and the successful establishment of traumatic hemorrhagic shock model （0 h） and then every 30 min after 0 h, serum levels of K^＋, Lac and Glu were detected. The features of varied serum K^＋, Lac and Glu were observed in each group. All data were statistically analyzed using One-way ANOVA and Pearson correlation analysis. Results After exposed, the level of serum K^＋ inside the dry-heat environment was higher than that of swine inside the normal temperature group （ P〈0.01）, however the Gin level was lower in the swine inside dry-heat environment than that of swine inside the normal temperature （ P〈0.01）.The level of serum K^＋ and Lac of DTHS group were rapidly increased from the establishment of the model to the death in about 3 h, while those of NTHS group were increased slowly. The level of K^＋ and Lac were positively correlated in the two groups amd the correlation coefficient were rDTHS=0.927 （P〈0.01） and rNTHS=0.539 （P〈0.01）,respectively. The level of Glu was progressively decrease in DTHS group, while in NTHS group, it was not noticeable. The level of K^＋ and Glu were negatively correlated in the two group, the correlation coefficient were rDTHS=-0.804 （P〈0.01） and rNTHS=0.420 （P〈0.01）,respectively. Conclusions The changes of serum K^＋, Lac and Glu occurred sooner and more obvious in traumatic hemorrhagic shock models inside dry heat environment （DTHS） group than those in NTHS group. The level of serum K^＋ positively correlated with Lac, however, negatively correlated with Glu, which suggested that hyperkalemia and acidosis should be paid more attention to the treatment of traumatic hemorrhagic shock inside the dry heat environment, and the hypoglycemia should be treated at the same time.