感染性休克早期多糖包被的变化及不同剂量液体复苏对其影响的研究

发布时间：2018-04-27 01:09

本文选题：脓毒症 + 液体复苏　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:感染性休克液体复苏的剂量一直以来都备受争议。本文拟观察内皮细胞多糖包被在感染性休克动物模型液体复苏过程中的相对变化并讨论液体复苏的剂量问题。方法:新西兰大白兔20只,随机分为脓毒症组和对照组,脓毒症组又分为低剂量组(30ml/Kg液体复苏)、高剂量组(60ml/kg液体复苏)和单纯脓毒症组(未予液体复苏),每组5只。运用LPS方法制作脓毒症兔模型,对照组给予耳缘静脉注射同等剂量5%葡萄糖注射液。静脉注射药物(对照组为葡萄糖注射液)后2小时由左颈总动脉置管连接压力换能器,通过生物信号采集处理系统连续监测有创动脉血压(ABP)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)。由右侧颈内静脉留置导管给予中心静脉补液及应用血管活性药物。分别于造模后0h、3h、6h抽取颈内动、静脉血液测定乳酸、血气、血浆多配体聚糖(Syndecan-1)水平。监测呼吸频率、意识及目测动物暴露部分(口唇、耳缘动静脉血管)微循环灌注情况。结果:(1)LPS后0h脓毒症组与对照组相比,血压明显下降,心率及呼吸频率增快。乳酸值:脓毒症组㧐对照组(三组分别对比),结果具有统计学差异(P0.05下同)。组内对比三组无明显统计学差异;中心静脉血氧饱和度(SCVO2)组间及组内对比结果与乳酸结果相一致。多配体聚糖(Syndecan-1):脓毒症组㧐对照组,结果有统计学差异,组内对比三组无明显统计学差异。(2)LPS后1h液体复苏完成,同时依据平均动脉压调整去甲肾上腺素(MAP≥65mm Hg)。3h血样本Syndecan-1浓度结果:脓毒症组㧐对照组(三组分别对比),结果有统计学意义。组内对比:单纯脓毒症组㧐高剂量组㧐低剂量组,结果具有统计学差异。(3)LPS后6h血样本Syndecan-1浓度结果显示,单纯脓毒症组样本浓度最高,且均高于另外三组,结果具有统计学差异;高剂量组、低剂量组、对照组三组样本浓度结果差异无统计学意义,但其浓度均值高剂量组㧐低剂量组㧐对照组。(4)组别内前后自身对比:低剂量组Syndecan-1浓度在整个实验过程中变化不明显,其差异不存在统计学意义。高剂量组Syndecan-1浓度在整个实验过程中变化明显。整体趋势呈现进行性增高趋势,0h样本浓度㧐3h样本浓度㧐6h样本浓度,其差异存在统计学意义。单纯脓毒症组Syndecan-1浓度前后变化明显。整体趋势呈现进行性增高趋势,0h样本浓度㧐3h样本浓度㧐6h样本浓度,但其0h与3h样本浓度差异无统计学意义,其0h样本浓度及3h样本浓度与6h样本浓度相比差异均存在统计学差异。对照组Syndecan-1浓度前后变化不明显。但其6h血样本浓度较0h及3h相比仍小幅度增高,其0h样本浓度与3h样本浓度差异无统计学意义,其0h样本浓度及3h样本浓度与6h样本浓度相比差异均存在统计学差异。(5)排除时间因素,进行组别间Syndecan-1浓度析因分析结果显示:单纯脓毒症组㧐高剂量组㧐低剂量组,结果具有统计学差异,其中低剂量组均值高于对照组,但结果无统计学差异。结论:对于感染性休克动物模型进行液体复苏,运用多糖包被标志物等分子生物学指标结果证实,保守剂量的液体复苏联合血管活性药可能可以减少其结构的脱落,对于感染性休克动物模型进行液体复苏,运用多糖包被标志物等分子生物学指标结果证实,保守剂量的液体复苏可能可以减少其结构的脱落,其结果可能对病人内皮细胞的保护及血管通透性的改善有积极意义。
[Abstract]:Objective: the dose of fluid resuscitation in septic shock has always been controversial. This article is to observe the relative changes in the fluid resuscitation in the animal model of septic shock and discuss the dose problem of the fluid resuscitation. Methods: 20 New Zealand white rabbits were divided into sepsis group and control group, and the sepsis group was divided into two groups. For low dose group (30ml/Kg fluid resuscitation), high dose group (60ml/kg liquid resuscitation) and simple sepsis group (no fluid resuscitation), 5 rabbits in each group were made by LPS method. The control group was given the same dose of 5% Glucose Injection in the ear vein. The intravenous drug (the control group was Glucose Injection) was left in the left neck 2 hours after the intravenous injection. The blood pressure (ABP), mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SPO2) were continuously monitored through the biologic signal acquisition and processing system. The central venous rehydration and the application of vasoactive drugs were given by the right internal jugular vein catheter. The internal carotid artery and venous blood were extracted after the model, 0h, 3h, 6h, respectively. Liquid determination of lactic acid, blood gas, plasma multi ligand polysaccharide (Syndecan-1) level. Monitoring respiratory frequency, awareness and visual measurement of animal exposure part (lip, auricular vein) microcirculation perfusion. Results: (1) after LPS 0h sepsis group compared with the control group, the blood pressure decreased significantly, heart rate and respiratory rate increased rapidly. The lactic acid value: sepsis group? Control group (three The results were statistically different (P0.05 below). There was no significant difference between the three groups. The results of the central venous blood oxygen saturation (SCVO2) were in accordance with the results of lactic acid. The results were statistically different in the group of sepsis and in the group of sepsis. There was no significant difference between the three groups. Difference. (2) after LPS, 1H fluid resuscitation was completed and the Syndecan-1 concentration of norepinephrine (MAP > 65mm Hg).3h blood samples was adjusted according to the average arterial pressure. The results were statistically significant in the sepsis group? Control group (three groups respectively). The results were statistically significant in the group of simple sepsis, high dose group and low dose group, and the results were statistically different. (3) LPS The results of Syndecan-1 concentration in the post 6h blood samples showed that the concentration of samples in the simple sepsis group was the highest and higher than the other three groups. The results were statistically different. There was no statistical difference between the high dose group, low dose group and the control group, but the mean concentration of the high dose group, the low dose group, the control group, and the control group. (4) the group in the low dose group and the control group. Syndecan-1 concentration in low dose group was not obvious during the whole experiment, and the difference was not statistically significant. The concentration of Syndecan-1 in high dose group changed obviously during the whole experiment. The overall trend showed progressive trend, the concentration of 0h sample? 3H sample concentration? 6h sample concentration, the difference was statistically significant. Pure sepsis The change of Syndecan-1 concentration in the disease group was obvious. The overall trend showed progressive trend, 0h sample concentration, 3h sample concentration and 6h sample concentration, but there was no statistical difference between the concentration of 0h and 3H samples, and the difference of 0h sample concentration and 3H sample concentration compared with 6h sample concentration were statistically different. The Syndecan-1 concentration in the control group was changed before and after. The concentration of 6h blood samples was still slightly higher than that of 0h and 3h, and there was no statistical difference between the concentration of 0h samples and the concentration of 3H samples. There was a statistical difference between the concentration of 0h samples and the concentration of 3H samples and the concentration of 6h samples. (5) the exclusion time factor and the result of the concentration analysis of Syndecan-1 concentration among the groups showed: single The results were statistically different in the high dose group, the high dose group and the low dose group, of which the low dose group was higher than the control group, but the results were not statistically significant. Conclusion: the liquid resuscitation in the animal model of septic shock and the results of molecular biologic indexes, such as the biomarker of polysaccharide envelope, were confirmed, and the conservative dose of liquid resuscitation combined with blood. The active drug may reduce the loss of its structure, the fluid resuscitation in the animal model of septic shock, and the results of molecular biological indicators, such as the biomarker of the polysaccharide package, confirm that the conservative dose of liquid recovery may reduce the loss of its structure, which may result in the protection of the endothelial cells of the patients and the alteration of the vascular permeability. Good is positive.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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