不同浓度高渗盐水对非控制性失血性休克家兔救治效果的研究

发布时间：2018-05-17 00:30

本文选题：兔 + 失血性休克　；参考：《第四军医大学》2015年硕士论文

【摘要】：目的探讨小剂量不同浓度高渗盐水(4.5%与7.5%)对非控制性失血性休克家兔早期液体复苏效果的影响。方法将实验家兔随机分为5组:假手术组(SHAM组)、休克未治疗组(SWT组)、生理盐水复苏组(NS组)、4.5%盐水复苏组(4.5%组)和7.5%盐水复苏组(7.5%组),建立非控制性失血性休克家兔模型,在设定时间内,采用预定方案进行液体复苏,家兔实验途中若有死亡,补充以保证每组有效家兔数量为8只。在实验0min、30min、60min以及90min监测以下指标:1.血流动力学指标(LVSP、±dp/dtmax、CVP、HR),由BL-420F生物信号采集系统监测所得。2.肾脏功能监测,在0min、30min、60min以及90min由股动脉插管抽取2ml动脉血,3000rpm离心15min后留取血清,试剂盒测BUN以及Cr含量。3.实验结束后统计出血量与输液量,空气栓塞处死家兔并留取心、肺、肾组织标本做HE染色切片。结果1.各组家兔在月龄、基础体重以及初始平均动脉压分别经单因素方差分析证实差异无统计学意义(P0.05),各组之间均衡性较好。2.急性失血操作对家兔血流动力学指标以及肾脏功能的影响急性失血操作后,SWT组、NS组、4.5%组以及7.5%组家兔LVSP、±dp/dtmax、CVP均有显著下降,并在15min时达到最低,30min时,SWT组、NS组、4.5%组以及7.5%组LVSP、±dp/dtmax、CVP之间两两比较差异没有统计学意义,但是均明显低于SHAM组(P0.05);血清BUN、Cr均明显上升,四组之间两两比较差异没有统计学意义,并明显高于SHAM组(P0.05);HR在实验过程中变化不明显。3.液体复苏对各组家兔血流动力学指标以及肾脏功能的影响给予液体复苏后,NS组、4.5%组、7.5%组LVSP、±dp/dtmax、CVP均有不同程度的上升,并明显高于SWT组(P0.05);NS组、4.5%组与7.5%组BUN、Cr在液体复苏后均有下降趋势,并显著低于SWT组(P0.05)。NS组、4.5%组、7.5%组三组之间相比,7.5%组以及4.5%组家兔LVSP、±dp/dtmax的改善要明显优于NS组(P0.05);7.5%组BUN、Cr明显低于NS组(P0.05),4.5%组与NS组、4.5%组与7.5%组之间BUN、Cr比较差异没有统计学意义;三组之间CVP差异没有统计学意义(P0.05)。4.各组家兔输液量以及继续出血量的比较NS组、4.5%组与7.5%组三组各时间段输液量比较差异没有统计学意义,但是7.5%组总输液量明显低于NS组(NS组=72.13±9.46ml,4.5%组=57.00±15.49ml,7.5%组=52.00±17.81ml);NS组、4.5%组与7.5%组液体输入后会增加继续出血量,其中NS组最高(6.15±0.56ml),7.5%组最低(4.89±0.34ml),但是三组之间差异没有统计学意义。5.HE染色结果高倍显微镜下观察,SHAM组心肺肾组织病理切片正常,SWT组各器官损伤较重,NS组、4.5%组、7.5%组病理切片略有改变但是要轻于SWT组,NS组、4.5%组、7.5%组三组之间各器官病理切片改变差异不明显。结论1.通过股动脉抽血方法可以成功建立失血性休克家兔模型,可以比较稳定地模拟失血性休克伤员伤后状态。2.液体复苏可以有效改善失血性休克后血流动力学指标以及肾脏功能指标。3.高渗盐溶液对于失血性休克的救治效果要优于生理盐水。4.与4.5%高渗盐溶液相比,7.5%高渗盐溶液在失血性休克家兔中的救治效果更优。
[Abstract]:Objective to investigate the effect of small dose of hypertonic saline (4.5% and 7.5%) on the effect of early fluid resuscitation in rabbits with non controlled hemorrhagic shock. Methods the experimental rabbits were randomly divided into 5 groups: sham operation group (group SHAM), shock untreated group (group SWT), saline resuscitation group (group NS), 4.5% saline resuscitation group (4.5% groups) and 7.5% saline resuscitation group (7.5%) A rabbit model of non controlled hemorrhagic shock was established. In the setting time, a predetermined solution was used to resuscitate the liquid. If there were death in the course of the rabbit, the number of effective rabbits in each group was 8. The following indexes were monitored in experimental 0min, 30min, 60min and 90min: 1. hemodynamic indexes (LVSP, + dp/dtmax, CVP, HR), and BL-420F 0min, 30min, 60min, and 90min were extracted from the arterial blood of the femoral artery, and the serum was extracted from the femoral artery intubation, 3000rpm centrifuged 15min and the serum were collected at the end of the 3000rpm centrifuge 15min. The amount of hemorrhage and the amount of transfusion were measured after the.3. experiment at the end of the Cr content, and the rabbits were killed and the specimens of the lungs and kidneys were stained with.2.. Results 1. each group of rabbits at the age of month, basal body weight and initial mean arterial pressure showed no significant difference (P0.05) respectively. The balance between each group was better than that of.2. acute blood loss operation on hemodynamic index and renal function in rabbits, group SWT, group NS, and group NS. And 7.5% groups of rabbits LVSP, + dp/dtmax, CVP all decreased significantly, and reached the lowest in 15min, 30min, SWT group, NS group, 4.5% groups and 7.5% groups of LVSP, + dp/dtmax, CVP 22, the difference was not statistically significant, but all obviously lower than SHAM group (P0.05), blood clear, the 22 difference was not statistically significant difference between the four groups. Significance, and obviously higher than group SHAM (P0.05); HR during the experiment did not change obviously the effect of.3. liquid resuscitation on the hemodynamic index and renal function of each group, after the fluid resuscitation, NS group, 4.5% groups, 7.5% groups of LVSP, + dp/dtmax, CVP have different degrees up, and obviously higher than the SWT group (P0.05); NS group, 4.5% groups and 7.5% groups BUN. After the fluid resuscitation, there was a downward trend, and significantly lower than group SWT (P0.05).NS group, 4.5% groups, 7.5% groups of three groups, 7.5% and 4.5% groups of rabbits LVSP, the improvement of + dp/dtmax was significantly better than the NS group (P0.05); the 7.5% group BUN, Cr significantly lower than the NS group (P0.05), 4.5% groups and NS, 4.5% and 7.5% groups, there was no statistical difference The difference of CVP between the three groups was not statistically significant (P0.05) the infusion volume of rabbits in.4. groups and the comparison of the continuous bleeding volume in the group NS, the 4.5% group and the 7.5% group three groups had no significant difference in the infusion volume, but the total infusion volume of the 7.5% groups was significantly lower than that of the NS group (NS group = 72.13 + 9.46ml, 4.5% groups =57.00 + 15.49ml, 7.5% =52.00 + 17.81ml. NS group, group NS, 4.5% groups and 7.5% groups of liquid input will increase the amount of continuous bleeding, among which group NS is the highest (6.15 + 0.56ml), the 7.5% group is the lowest (4.89 + 0.34ml), but there is no statistically significant difference between the three groups. The pathological section of the group SHAM in the group of cardiopulmonary kidney is normal, the injury of each organ in the group SWT is heavier, NS, 4.5%, 7.5%. The pathological section of the group was slightly changed, but it should be lighter than the SWT group, group NS, 4.5% groups, and 7.5% groups and three groups, the difference of pathological sections of each organ was not obvious. Conclusion 1. can successfully establish a rabbit model of hemorrhagic shock through the femoral artery blood extraction. It can be more stable to simulate the recovery of.2. liquid in the state of the injured patients after injury. The hemodynamic index and renal function index.3. hypertonic salt solution for hemorrhagic shock after hemorrhagic shock is better than the saline.4. and 4.5% hypertonic salt solution, and the treatment effect of 7.5% hypertonic salt solution in hemorrhagic shock rabbits is better.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.7

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