液体复苏对腹腔高压家猪血流动力学和脑灌注影响以及每搏输出量变异评估价值的实验研究

发布时间：2018-05-24 13:40

  本文选题：腹腔高压 + 腹腔间隔室综合征　； 参考：《南京大学》2013年硕士论文

【摘要】：第一部分腹腔高压对低血容量家猪血流动力学及脑灌注的影响 [摘要]目的探讨不同程度腹腔高压(IAH)对低血容量家猪血流动力学及脑灌注的影响。方法选择实验家猪40只,经颈动脉释放家猪30%血容量,维持家猪低血容量状态,按随机数字表法将家猪随机分为四组(IAPL0、IAPL15、IAPl25和IAPL35组),采用氮气(N2)气腹法分别维持IAP为0、15、25和35mmHg即IAPL0组、IAPL15组、IAPL25组和IAPL35组,稳定30min后采用脉搏轮廓连续心排血量监测(PiCCO)法监测各组家猪心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排血量(CO)、全心舒张末期容积指数(GEDVI)和每搏输出量指数(SVI)等血流动力学指标,脑室内置入颅内压光纤探头,连接颅内压监测仪连续监测颅内压(ICP),计算脑灌注压(CPP)。结果(1)与IAPLo组比较,IAPL15、IAPL25和工APL35组均表现为HR增快,GEDVI和SVI降低,SVRI增加,CVP升高(P均0.05),且各腹腔高压组(IAPL155、IAPL25 和IAPL35组)间比较差异均具有统计学意义(P均0.05)；与IAPL0组比较,IAPL15组MAP增加(P0.05),而IAPL25组和IAPL35组MAP无明显变化(P0.05),IAPL15组CI无明显变化(P＞0.05),而IAPL25组和IAPL35组CI则显著下降(P0.05)；EVLWI各组间比较均无显著差异(P0.05)；(2)与IAPLo组比较,IAPL15组ICP无明显变化(P＞0.05),IAPL25和IAPL35组ICP均明显增加(P0.05), IAPL15、IAPL25和IAPL35组CPP均无明显变化(P＞0.05)；与IAPu5组比较,IAPL25和IAPL35组CPP均显著降低(P0.05)。结论腹腔高压可以导致心排血量减少,颅内压升高,脑灌注减少,并且腹腔压力越高,影响越显著。 第二部分液体复苏对腹腔高压家猪血流动力学及脑灌注的影响 [摘要]目的探讨液体复苏对低血容量的腹腔高压家猪血流动力学及脑灌注的影响。方法选择实验家猪40只,经颈动脉释放家猪30%血容量,维持家猪低血容量状态,按随机数字表法随机分为四组(IAPLo组、IAPL15组、IAPL25组和IAP-5组),采用氮气气腹法分别维持IAP为0、15、25和35mmHg即IAPLo组、IAPL15组、IAPL25组和IAPL35组,各组均稳定30min后快速静脉输注羟乙基淀粉500ml进行液体复苏,采用PiCCO法分别于复苏前及复苏后30min监测各组家猪HR、MAP、CVP、CI、GEDVI和SVI等血流动力学指标,脑室内置入颅内压光纤探头,连接颅内压监测仪连续监测ICP变化,计算CPP。结果(1)IAPL。组、IAPL15组、IAP-5组和IAPL35组经液体复苏后均表现为HR下降,MAP升高,CI、GEDVI和SVI增加(P均0.05),CVP则无明显变化(P＞0.05),IAPL15组、IAPL25组和IAPL35组SVRI显著下降(P均0.05)；各组EVLWI无明显变化(P均0.05)；(2)IAPLo组、IAPL15组、IAP-5组和IAPL35组,液体复苏后ICP均显著升高(P均0.05),IAPL25和IAPL35组CPP亦显著增加(P均0.05),而IAPL15组CPP无明显变化(P0.05)。结论腹腔高压时,液体复苏可以增加低血容量家猪的心排血量,改善家猪循环状态,但有增加颅内压的风险。第三部分每搏输出量变异评价腹腔高压家猪液体反应性的实验研究[摘要]目的探讨每搏输出量变异(SVV)评价腹腔高压家猪液体反应性的准确性以及不同程度腹腔高压对其准确性的影响。方法选择实验家猪40只,经颈动脉释放家猪30%血容量,维持家猪低血容量状态,并按随机数字表法随机分为四组(IAPL0组、IAPL15组、IAPL25组和IAPL35组),采用氮气气腹法分别维持IAP为0、15、25和35mmHg即IAPL0组、IAPL15组、IAPL25组和IAPL35组,稳定30min后均给予羟乙基淀粉500ml快速静脉滴注进行液体复苏,采用PiCCO法分别于复苏前及复苏后30min监测各组家猪SVV、CVP、CO、GEDVI、SVI等血流动力学指标的变化。将液体复苏前、后每搏输出量变化(ΔSV%)≥15%定义为液体有反应。结果(1)与IAPLo组比较,IAPL15、IAPL25和IAPLa5组SVV均显著增加(P0.05)；与IAPL15组相比,IAPL25组SVV无明显变化(P＞0.05),IAPL35组SVV显著增加(P0.05)；(2)液体复苏后,IAPL0组SVV显著降低(P0.05),而IAPL15、IAPL25和IAPL35组均无明显变化(P＞0.05)；(3)IAPL0、IAPL15、IAPL25和IAP-5组CVP与ΔSV%均无显著相关性(r分别为0.205、-0.161、-0.24和0.217,P均0.05)；(4)IAPL0和IAPL15组家猪SVV与△SV%呈显著正相关(r分别为0.888和0.942,P0.05),而IAPL25和IAPL35组SVV与ASV%均无明显相关性(r分别为0.851和-0.114,P＞0.05)。结论腹腔压力轻度升高时(IAP≤15mmHg)SW可有效预测液体反应性,而重度腹腔高压时SVV不能准确预测液体反应性,需进一步探讨其影响因素。
[Abstract]:Effects of the first part of abdominal pressure on the flow dynamics and cerebral perfusion in swine with low blood volume

Objective To investigate the effects of different degrees of intraperitoneal high pressure ( IAH ) on the flow dynamics and cerebral perfusion in swine with low blood volume . Methods : Forty healthy pigs were randomly divided into four groups ( IAPL0 , IAPL15 , IAPl25 and IAPL35 ) by using nitrogen ( N2 ) methods . Results ( 1 ) Compared with the IAPLo group , the patients with IAPL15 , IAPL25 , and APL35 were randomly divided into four groups ( IAPL0 , IAPL25 , and IAPL35 ) . The results showed that the ratio of GEDVI and SVI decreased , SVRI increased , CVP increased ( P < 0.05 ) , and the IPL15 , IAPL25 and IAPL25 groups were divided into four groups : IAPL155 , IAPL25 and IAPL25 .

Compared with the IAPL35 group , the difference was statistically significant ( P < 0.05 ) .
Compared with the IAPL0 group , the MAP of IAPL15 group increased ( P0.05 ) , but there was no significant change in MAP in IAPL25 group and IAPL35 group ( P0.05 ) , but CI in IAPL25 group and IAPL35 group decreased significantly ( P0.05 ) .
There was no significant difference between EVLWI and EVLWI ( P0.05 ) .
( 2 ) Compared with the IAPLo group , there was no significant change in ICP in IAPL15 group ( P > 0.05 ) , ICP in IAPL25 and IAPL35 group was significantly increased ( P0.05 ) , there was no significant change in CPP in IAPL15 , IAPL25 and IAPL35 group ( P > 0.05 ) ;
Compared with IAPu5 group , the CPP in IAPL25 and IAPL35 group decreased significantly ( P0.05 ) . Conclusion Abdominal high pressure can result in the decrease of cardiac output , the increase of intracranial pressure , the decrease of cerebral perfusion , and the higher the abdominal pressure , the more significant the effect is .

Effects of the second part of liquid resuscitation on the flow dynamics and cerebral perfusion of swine in abdominal cavity

Objective To investigate the effects of liquid resuscitation on hemodynamics and cerebral perfusion in abdominal high pressure patients with low blood volume . The results showed that 40 rats were randomly divided into four groups ( IAPLo group , IAPL15 group , IAPL25 group and IAP - 5 group ) by using nitrogen gas - abdominal method . The results showed that the HR , MAP , CVP , CI , GEDVI and SVI were all stable in group IAPL15 , IAPL25 and IAPL . Results ( 1 ) There was no significant change in the MAP , CI , GEDVI and SVI ( P > 0.05 ) , and the SVRI in IAPL15 , IAPL25 and IAPL35 groups decreased significantly ( P < 0.05 ) .
There was no significant change in EVLWI in each group ( P < 0.05 ) .
The results ( 1 ) were compared with the group of IAPL0 group , IAPL15 group , IAPL25 group and IAPL35 group . Results ( 1 ) Compared with the IAPLo group , the IAPL15 , IAPL25 and IAPLa5 groups increased significantly ( P0.05 ) .
Compared with the IAPL15 group , the IAPL25 group had no significant change ( P > 0 . 05 ) , and that of the IAPL35 group was significantly increased ( P0.05 ) .
( 2 ) After resuscitation , the IAPL0 group decreased significantly ( P0.05 ) , but there was no significant change in IAPL15 , IAPL25 and IAPL35 groups ( P > 0.05 ) .
( 3 ) There was no significant correlation between CVP and 螖SV % in IAPL0 , IAPL15 , IAPL25 and IAP - 5 ( r = 0.205 , - 0.161 , - 0.24 and 0.217 , P < 0.05 ) .
( 4 ) There was a significant positive correlation between IAPL0 and IAPL15 ( r = 0.888 and 0.942 , P0.05 ) , but there was no significant correlation between IAPL25 and IAPL35 group ( r = 0.851 and - 0.114 , P > 0.05 ) . Conclusion When the abdominal pressure is slightly elevated ( IAP 鈮，

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