出血性休克失血未控制早期限制性液体复苏效果及机制研究
发布时间：2018-11-20 08:00
【摘要】：目的： 研究早期进行限制性液体复苏对出血未控制的创伤性休克的治疗效果及机制。 方法： 本实验采用控制性颈动脉放血法建立出血未控制性休克兔模型,具体方法如下： (1)新西兰雄性兔42只,随机分为3组。每组14只：无液体复苏组(对照组)、小剂量液体复苏组、大剂量液体复苏组。 (2)动态观察休克前后及补液治疗后1h,2h,3h,4h兔的MAP及各项实验室指标。 (3)统计各组休克后4h病死率情况,统计分析比较各时间段MAP及各项实验室指标数据。 (4)HE染色后在电子显微镜下观察并比较心、肺、肝、肾组织的病理变化。 结果： (1)无液体复苏组、小剂量液体复苏组、大剂量液体复苏组4h病死率分别为71%、7%、36%,小剂量组显著低于无补液组(P=0.001),大剂量组与无补液组相比差异无统计学意义,表明限制性液体复苏可以降低病死率。 (2)小剂量液体复苏组较大剂量组、无液体复苏组相比,血液中的RBC下降明显减少,有统计学意义(P0.05),而大剂量组RBC值与无液体复苏组无差异(P0.05)。表明限制性液体复苏可以避免血液过度稀释,增加组织氧供。 (3)比较各时间点乳酸、血钾浓度,小剂量组较大剂量组、无液体复苏组均有显著下降(P0.05),表明限制性液体复苏能减轻酸中毒,维持组织内环境稳定。 (4)各组CK-MB、肌酐浓度,小剂量组较大剂量组、无液体复苏组均有显著下降(P0.05),表明限制性液体复苏可以维持各器官功能的稳定。 (5)病理结果显示：各实验组存活动物心、肺、肝、肾都有一定程度病理损伤,但是小剂量液体复苏组损伤程度较未补液组、大剂量液体复苏组较轻。表明限制性液体复苏可以防止器官受到进一步的病理损伤。 结论： (1)对于非控制性出血性休克,在确定性手术止血之前进行低压复苏(MAP50-60mmHg)较之大剂量液体复苏(MAP70-80mmHg)能显著延长休克动物的存活时间,降低早期病死率； (2)限制性液体复苏可以在一定程度上防止血液过度稀释,从而增加血液的携氧能力；减轻酸中毒,维持各器官功能,机体内环境及细胞代谢的稳定；减轻休克液体复苏对心、肺、肝、肾的病理损伤,更有利于预后。
[Abstract]:Objective: to study the therapeutic effect and mechanism of early restrictive fluid resuscitation on traumatic shock with uncontrolled hemorrhage. Methods: the rabbit model of uncontrolled hemorrhagic shock was established by controlled carotid artery bleeding. The methods were as follows: (1) 42 New Zealand male rabbits were randomly divided into 3 groups. There were 14 rats in each group: no fluid resuscitation group (control group), low dose fluid resuscitation group and high dose fluid resuscitation group. (2) the MAP and laboratory indexes of rabbits before and after shock were observed dynamically. (3) the death rate of 4 hours after shock was analyzed and compared with MAP and laboratory data. (4) the pathological changes of heart, lung, liver and kidney were observed and compared under electron microscope after HE staining. Results: (1) the fatality rate of fluid free resuscitation group, low dose fluid resuscitation group and high dose liquid resuscitation group was 71and 7360.The mortality of the low-dose group was significantly lower than that of the non-resuscitation group (P0. 001). There was no significant difference between the high dose group and the non-rehydration group, indicating that restricted fluid resuscitation could reduce the mortality. (2) the decrease of RBC in blood was significantly decreased in the small dose fluid resuscitation group and the non-liquid resuscitation group (P0.05), but the RBC value in the high-dose group was not different from that in the non-liquid resuscitation group (P0.05). Restrictive fluid resuscitation can avoid excessive hemodilution and increase tissue oxygen supply. (3) compared the concentration of lactic acid and potassium in blood at different time points, the concentration of lactic acid and potassium in small dose group and non-liquid resuscitation group were significantly decreased (P0.05), which indicated that restrictive fluid resuscitation could alleviate acidosis and maintain the stability of tissue environment. (4) CK-MB, creatinine concentration in each group, small dose group, large dose group, no fluid resuscitation group were significantly decreased (P0.05), indicating that restrictive fluid resuscitation can maintain the stability of organ function. (5) the pathological results showed that the heart, lung, liver and kidney of all experimental groups were damaged to some extent, but the injury degree of the small dose fluid resuscitation group was lower than that of the non-resuscitation group, and the high dose liquid resuscitation group was lighter. This suggests that restricted fluid resuscitation can prevent further pathological damage to organs. Conclusion: (1) for uncontrolled hemorrhagic shock, hypobaric resuscitation (MAP50-60mmHg) before definitive operation can significantly prolong the survival time of shock animals compared with high-dose fluid resuscitation (MAP70-80mmHg). Reducing early mortality; (2) restrictive fluid resuscitation can prevent excessive hemodilution to a certain extent, increase the oxygen carrying capacity of blood, reduce acidosis, maintain the function of various organs, and stabilize the environment and cell metabolism of the body. Reducing the pathological injury of heart, lung, liver and kidney caused by shock fluid resuscitation is more favorable for prognosis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7
本文编号：2344327
[Abstract]:Objective: to study the therapeutic effect and mechanism of early restrictive fluid resuscitation on traumatic shock with uncontrolled hemorrhage. Methods: the rabbit model of uncontrolled hemorrhagic shock was established by controlled carotid artery bleeding. The methods were as follows: (1) 42 New Zealand male rabbits were randomly divided into 3 groups. There were 14 rats in each group: no fluid resuscitation group (control group), low dose fluid resuscitation group and high dose fluid resuscitation group. (2) the MAP and laboratory indexes of rabbits before and after shock were observed dynamically. (3) the death rate of 4 hours after shock was analyzed and compared with MAP and laboratory data. (4) the pathological changes of heart, lung, liver and kidney were observed and compared under electron microscope after HE staining. Results: (1) the fatality rate of fluid free resuscitation group, low dose fluid resuscitation group and high dose liquid resuscitation group was 71and 7360.The mortality of the low-dose group was significantly lower than that of the non-resuscitation group (P0. 001). There was no significant difference between the high dose group and the non-rehydration group, indicating that restricted fluid resuscitation could reduce the mortality. (2) the decrease of RBC in blood was significantly decreased in the small dose fluid resuscitation group and the non-liquid resuscitation group (P0.05), but the RBC value in the high-dose group was not different from that in the non-liquid resuscitation group (P0.05). Restrictive fluid resuscitation can avoid excessive hemodilution and increase tissue oxygen supply. (3) compared the concentration of lactic acid and potassium in blood at different time points, the concentration of lactic acid and potassium in small dose group and non-liquid resuscitation group were significantly decreased (P0.05), which indicated that restrictive fluid resuscitation could alleviate acidosis and maintain the stability of tissue environment. (4) CK-MB, creatinine concentration in each group, small dose group, large dose group, no fluid resuscitation group were significantly decreased (P0.05), indicating that restrictive fluid resuscitation can maintain the stability of organ function. (5) the pathological results showed that the heart, lung, liver and kidney of all experimental groups were damaged to some extent, but the injury degree of the small dose fluid resuscitation group was lower than that of the non-resuscitation group, and the high dose liquid resuscitation group was lighter. This suggests that restricted fluid resuscitation can prevent further pathological damage to organs. Conclusion: (1) for uncontrolled hemorrhagic shock, hypobaric resuscitation (MAP50-60mmHg) before definitive operation can significantly prolong the survival time of shock animals compared with high-dose fluid resuscitation (MAP70-80mmHg). Reducing early mortality; (2) restrictive fluid resuscitation can prevent excessive hemodilution to a certain extent, increase the oxygen carrying capacity of blood, reduce acidosis, maintain the function of various organs, and stabilize the environment and cell metabolism of the body. Reducing the pathological injury of heart, lung, liver and kidney caused by shock fluid resuscitation is more favorable for prognosis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7
【参考文献】
相关期刊论文 前2条
1 张吉新;李士华;毕宝林;崔兆伟;张颖;;创伤失血性休克的液体复苏[J];创伤外科杂志;2008年03期
2 黄善灶;;限制性液体复苏治疗严重多发伤失血性休克临床分析[J];中国急救复苏与灾害医学杂志;2008年06期
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