应用血管活性药物的目标导向限制性液体复苏救治严重多发伤兔的研究

Study on the Therapeutic Effect of Target-Directed Restricted Fluid Resuscitation with Vasoactive Drugs on Rabbits with Severe Multiple Injuries

目的研究应用血管活性药物对未控制出血的创伤性休克的作用效应。方法通过构建未控制出血的创伤性休克动物模型,应用充分补液(C组)及血管活性药物限制性补液(D组),以假手术兔(A组)和不控制处理组(B组)为对照组,评价平均动脉压(MAP)、心率、血气分析、凝血功能和存活等指标,根据目标导向液体复苏原则,研究应用血管活性药物对复苏液体量、内环境以及救治效果的影响。结果C组MAP在T90时略低于D组,但差异无统计学意义(P>0.05);C组心率在T30和T90时略低于D组,但差异无统计学意义(P>0.05)。两组兔子的pH值、动脉血二氧化碳分压(PaCO_(2))、HCO_(3)^(-)、碱剩余(BE)、乳酸、血糖、K+和Hct在不同时间点的数值接近,差异无统计学意义(P>0.05)。C组和D组在T90和T150时间点的凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)显著高于A组,差异有统计学意义(P<0.05)。另外在APTT上,D组相较于C组显著降低,差异有统计学意义(P<0.05)。此外,C组和D组的存活率差异无统计学意义(P=0.79)。结论应用血管活性药物的目标导向限制性液体复苏策略对严重多发伤兔救治与充分补液对MAP、心率、血气分析、凝血功能和存活等指标的影响相当,限制性补液联合血管活性药物能够作为一种有效的急救措施应用于实践。

Objective To study the effect of vasoactive drugs on uncontrolled traumatic shock.Methods An animal model of traumatic shock with uncontrolled bleeding was constructed,and adequate fluid supplementation(group C)and restricted fluid supplementation with vasoactive drugs(group D)were used as the experiment group.Sham-operated rabbits(group A)and uncontrolled treatment group(group B)were used as the control group.Indicators including MAP,heart rate,blood gas analysis,coagulation function,and survival were evaluated.According to the principle of goal-oriented fluid resuscitation,the effects of vasoactive drugs on resuscitation fluid volume,internal environment,and treatment effects were studied.Results The MAP of group C was slightly lower than that of group D at T90,but the difference was not statistically significant(P>0.05).The heart rate of group C was slightly lower than that of group D at T30 and T90,but the difference was not statistically significant(P>0.05).The values of pH,PaCO_(2),HCO_(3)^(-),BE,lactic acid,blood glucose,K+and Hct of the two groups of rabbits were close at different time points,and the difference was not statistically significant(P>0.05).The time of PT and APTT at T90 and T150 in group C and D was significantly higher than that of group A,and the difference was statistically significant(P<0.05).In addition,in terms of APTT time,group D was significantly lower than group C,and the difference was statistically significant(P<0.05).In addition,there was no statistical difference in survival between group C and group D(P=0.79).Conclusion The goal-directed restrictive fluid resuscitation strategy using vasoactive drugs has the same effect on the treatment of severe multiple injury rabbits on MAP,heart rate,blood gas analysis,coagulation function,and survival as that of adequate fluid rehydration.Restricted fluid rehydration combined with vasoactive drug can be an effective first-aid measure to be applied in practice.