压力记录分析法指导的目标导向液体治疗失血性休克兔的效果

Goal-directed fluid therapy in hemorrhagic shock rabbits guided by pressure recording analytical method

目的探讨压力记录分析法(pressure recording analytical method,PRAM)指导的目标导向液体治疗(goal-directed fluid therapy,GDFT)对失血性休克兔的效果。方法建立失血性休克兔模型40只,随机分为两组,每组20只。试验组(G组)以PRAM指导失血性休克兔的液体治疗,对照组(C组)以传统静态参数指导液体治疗。记录两组液体治疗期间液体总入量、晶体液入量、胶体液入量、自体血输入量、尿量、血管活性药物的使用情况、动物死亡数量,并记录造模前(T_(0))、失血性休克时(T_(1))、液体治疗30 min(T_(2))、液体治疗60 min(T_(3))、液体治疗90 min(T4)时的血流动力学指标及血气分析数值。结果与C组比较,G组液体总入量、晶体液入量及自体血输入量减少,胶体液入量及尿量增多,差异有统计学意义(P<0.05)。T_(2)-T_(3)时间点,G组MAP明显高于C组,HR明显低于C组,差异有统计学意义(P<0.05)。各组T_(2)-T4时点MAP及HR均显著高于T_(1)时点;T_(2)-T_(3)时点,MAP均显著低于T_(0)时点,HR均显著高于T_(0)时点(P<0.05)。与C组比较,G组T_(2)-T_(3)时间点PaO_(2)、BE明显增高,pH、PaCO_(2)、Lac显著降低。T_(1)时点两组PaO_(2)、pH、BE均较T_(0)时点显著降低,PaCO_(2)、Lac较T_(0)时点显著升高(P<0.05);T_(2)-T4时点,两组PaO_(2)、pH、BE与T_(1)时点相比均有逐步升高,PaCO_(2)、Lac均逐步下降,T_(2)-T_(3)时点各指标与T_(0)相比差异有统计学意义(P<0.05)。结论PRAM指导的GDFT能够改善血流动力学状况、纠正代谢性酸中毒,优化液体输入量和液体配比、减少自体血的输入,比传统液体治疗方案更有优势。

Objective To evaluate the therapeutic effect of the goal-directed fluid therapy guided by pressure recording analytical method(PRAM)against hemorrhagic shock rabbits.Methods Forty hemorrhagic shock rabbits were randomly divided into two groups:goal-directed fluid therapy group(group G)and the traditional fluid therapy group(group C),with 20 cases in each.The total fluid intake,crystal fluid intake,colloid fluid intake,autologous blood input,urine volume,vasoactive drug usage,and animal deaths during fluid therapy were recorded.The hemodynamic indexes and blood gas values were calculated beforemodeling(T_(0)),upon hemorrhagic shock(T_(1)),30 minutes after liquid treatment(T_(2)),60 minutes afterliquid treatment(T_(3)),and 90 minutes afterliquid treatment(T4).Results Compared with group C,the total fluid intake,crystalloid intake and autologous blood input in group G decreased,while the colloidal fluid intake and urine output increased,with statistically significant difference(P<0.05).Two patients in group G and five patients in group Ctook vasoactive drugs.Compared to group C,MAP,PaO_(2) and BE were significantly increased in groupGat T_(2) and T_(3),while HR,pH,PaCO_(2) and Lac were significantly decreased.Inboth groups,MAP,HR,PaO_(2),pH and BE were more significantly increased at T_(2) to T4 than at T_(1),while MAP,PaO_(2),pH and BE were more significantly decreased at T_(2) and T_(3) than at T_(0),but HR,PaCO_(2) and Lac were more significantly increased than at T_(0)(P<0.05).Conclusions The goal-directed fluid therapy guided by pressure recording analysis method has advantages over traditional fluid therapies in that this approach can improve hemodynamic status,ameliorate metabolic acidosis,optimize the fluid input and fluid ratio,and reduce autologous blood inputs.