摘要
目的研究羟乙基淀粉经骨髓通路复苏失血性休克的效果。方法成年新西兰白兔40只,随机分为两组(20只)。失血性休克模型复制成功后,对照组(20只)经外周静脉给予6%羟乙基淀粉(HES,130/0.4,4ml/kg);实验组(20只)经骨髓通路给予6%羟乙基淀粉(HES,130/0.4,4ml/kg);此后两组都给予等量生理盐水,并回输所失血液复苏。观察各组收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、呼吸频率(RR),并在休克后6小时内(15、30、60、90、120、150、180、360分钟)按时留取血标本8次(每次3ml)检验羟乙基淀粉含量(BHC)。监测动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)及乳酸水平(BL),并计算乳酸清除率(LCR)和氧合指数(PaO2/FiO2)。结果复苏开始15分钟内MAP全部回升至90mmHg以上,实验组与对照组在各个时间点基本生命体征:SBP、DBP、MAP、CVP、HR及RR均无统计学差异(全部P>0.05)。血羟乙基淀粉浓度(mg/L)在各个时间点均无统计学差异(全部P>0.05);实验前(-90分)乳酸值、动脉血氧分压、二氧化碳分压、氧合指数;休克时(0分)乳酸值、动脉血氧分压二氧化碳分压、氧合指数;复苏后(360分)乳酸值、动脉血氧分压、二氧化碳分压、氧合指数;以及乳酸清除率均无统计学差异(全部P>0.05)。结论失血性休克兔用6%羟乙基淀粉复苏能取得较好的效果,骨髓通路可以得到与静脉通路取得相同的效果。
Objective To evaluate the effect on the resuscitation of hemorrhagic shock rabbits by hydroxyethyl starch via intraosseous（IO） access in a randomized experimental study.Methods Forty new Zealand rabbits were randomized to two groups： IO group（6% Hydroxyethyl starch 130/0.4 via intraosseous access） and IV group（6% hydroxyethyl starch 130/0.4 via intravenous access）,20 rabbits in each group.Hemorrhagic shock model was induced by bleeding through the left internal carotid artery.Subjects received HES（4mg/kg）,normal saline（4mg/kg） and the lost blood.Parameters were observed including systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,central venous pressure（CVP）,respiratory rate（RR）,heart rate（HR）,arterial partial pressure of oxygen（PaO 2）,arterial partial pressure of carbon dioxide（PaCO2）,oxygenation index（PaO2/FiO2）,blood lactic acid（BL）and blood lactic acid clearance rate（LCR）.Serial artery blood samples（3ml） were taken at baseline and at 8 time points within 6 hours post-resuscitation.Blood samples were analyzed for HES concentration（BHC）,PaO2/FiO2 and LCR were calculated from the data.Data were analyzed by test of normality,independent-samples t test,paired-samples t test and levene＇s test.Results All MAP reached 90mmHg within 15 minutes after resuscitation and no statistically significant differences on each time point were observed between intraosseous and intravenous about SBP,DBP,MAP,CVP,HR,RR and BHC（P〉0.05）.The BHC had no statistically significant difference（P〉0.05）.Also,There were no significant differences between IO and IV route about the BL,PaO2,PaCO2,PaO2/FiO2 at 90 minutes before the experiment,at the time of shock,and at 360 minutes after resuscitation（P〉0.05）.Conclusion The use of 6% hydroxyethyl starch on the resuscitation of hemorrhagic shock rabbits via intraosseous（IO） access is feasible,and the effect of intraosseous access is equivalent to conventional intravenous access for resuscitation.
出处
《创伤外科杂志》
2011年第1期21-26,共6页
Journal of Traumatic Surgery
关键词
失血性休克
羟乙基淀粉
复苏
骨髓通路
氧合指数
乳酸清除率
hemorrhagic shock
hydroxyethyl starch
resuscitation
intraosseous access
oxygenation index
blood lactic clearance rate
