未控制出血性休克早期液体复苏的实验研究

Experimental study of fluid resuscitation in uncontrolled hemorrhagic shock

目的 :探讨未控制出血性休克限制性液体复苏的效果。方法 :Wistar大鼠 6 0只 ,采用 Krausz标准脾脏损伤 +切断脾中部一动脉分支制作重度未控制出血性休克模型后 ,随机分为 6组 (n=10 ) :未输液复苏组(NF组 )及平均动脉压维持在 6 .6 7k Pa(1k Pa=7.5 mm Hg)组 (NS5 0组 )、8.0 0 k Pa组 (NS6 0组 )、10 .70 k Pa组 (NS80组 )、13.30 k Pa组 (NS10 0组 )和结扎止血后使平均动脉压维持在 13.30 k Pa组 (止血输液组 )。各输液组在平均动脉压降至 5 .33k Pa时开始用平衡盐液复苏 ,使血压分别维持在各相应水平 ,观察各组动物的出血量、输液量、存活率、存活时间及各时间点的血压、血乳酸、碱缺失和血细胞比容 (Hct)的变化情况。结果 :NS5 0组的出血量、输液量明显低于 NS80、NS10 0组 (P均 <0 .0 5 ) ,存活率明显高于 NS80、NS10 0组和未输液组(P均 <0 .0 5 ) ,存活时间比未输液组、NS80和 NS10 0组明显延长 (P均 <0 .0 5 ) ;随着维持血压的增高 ,Hct逐渐降低 ,伤后 12 0分钟 NS5 0组明显高于 NS6 0组、NS80组和 NS10 0组 (P均 <0 .0 5 ) ;在各时间点 ,血乳酸和碱缺失随着复苏血压的增高而逐渐降低 ,伤后 6 0分钟 ,NS5 0组明显高于 NS6 0组、NS80组、NS10 0组和止血输液组 (P均 <0 .0 5 )。结扎止血组各项指?

Objective:To investigate the effect of limited resuscitation in a model of uncontrolled hemorrhagic shock. Methods:Uncontrolled hemorrhagic shock was produced in 60 rats by a standardized massive splenic injury with a transected middle branch of splenic artery (MSIA). When the mean arterial pressure(MAP) reached 40mmHg ,resuscitation was begun. Ringer's solution in fusion was continued as needed to maintain the following desired endpoints: group 1 consisted of untreated control(no resuscitation),group 2 to MAP of 6 67 kPa(1 kPa=7 5 mmHg), group 3 to MAP of 8 00 kPa, group 4 to MAP of 10 70 kPa, group 5 to MAP of 13 30 kPa, group 6 to MAP of 13 30 kPa after hemostasis.Animals were observed for 3 hours or untill death. Results:All rats in group 4 or group 5 died within 3 hours. Six rats in group 2 survived 3 hours,4 rats in group 3 survived 3 hours ( P <0 05, group 2 or group 3 vs.group 4 or group 5).The blood loss and the amount of fluid resuscitation in group 2 was significantly lower than that in group3,4,5,6 (all P <0 05).Mean survival time 〔(174 00±13 42)minutes〕 in group 2 was significantly longer than in group 4,5,6 (all P <0 05 ).Hematocrit in group 2 was significantly higher than in group 4,5,6 (all P <0 05). Conclusions: Attempts to achieve normal MAP during uncontrolled bleeding result in increased hemorrhage volume and marked higher mortality. Limited resuscitation before hemostasis could improve survival.