摘要
目的 观察全血、晶体液及胶体液对急性失血性休克兔肠系膜微循环的影响.方法 利用股动脉放血复制急性失血性休克模型,以平均动脉压（MAP）下降至40 mm Hg并稳定30 min作为模型成功的标准.动物数字法随机分成空白对照组、全血复苏组、林格氏液复苏组和羟乙基淀粉复苏组,每组7只,MAP至少恢复至基础水平的90％时认为液体复苏达标.肠系膜微循环采用旁流暗视野（SDF）成像仪器进行图像采集,通过总血管密度（TVD）、灌注血管密度（PVD）、灌注血管比例（PPV）及微血管血流指数（MFI）对肠系膜微循环进行评价.分别在基础状态时、失血性休克时、复苏达标时（Res-0）和复苏达标30 min时（Res-30）进行数据采集.结果 各组动物一般情况、全身血流动力学及肠系膜微循环在基础状态时无明显差异,在失血性休克时各组动物MAP均在40 mm Hg左右,认为急性失血性休克模型复制成功.与失血性休克时相比,液体复苏可使全血复苏组MAP[（39.6 ±2.4） mm Hg比（69.0±6.1）mm Hg],林格氏液复苏组MAP[（39.6±1.5） mm Hg比（63.9±7.3） mmHg],羟乙基淀粉复苏组MAP[（39.1±2.2）mm Hg比（67.1 ±7.8） mm Hg]在复苏达标时明显升高（均P＜0.05）,基本恢复至基础状态时水平.与失血性休克时相比,液体复苏均可使TVD、PVD、PPV和MFI在Res-0时和Res-30时升高,在Res-0时,羟乙基淀粉复苏组TVD（16.1±2.8）比（21.2 ±4.0）,PVD（16.0 ±2.8）比（21.2±4.0）显著低于林格氏液复苏组（均P＜0.05）,在Res-30时,各组肠系膜微循环指标差异无统计学意义（P＞0.05）.结论 急性失血性休克时,早期采用全血及林格氏液复苏可更好地改善肠系膜微循环.
Objective To explore the effects of blood,crystalloid and colloid on mesenteric microcirculation in rabbits of acute hemorrhagic shock.Methods Hemorrhagic shock was induced in 28anesthetized mechanically ventilated rabbits by withdrawing blood to a mean arterial blood pressure （MAP） of 40 mm Hg and maintained for 30 min.The animals were randomized into blank control group,whole blood resuscitation group,Ringer＇s solution resuscitation （RR） group and volume resuscitation （VR） group （n =7 each）.The data of vital signs,systemic hemodynamic parameters,arterial blood gas analysis and mesenteric microcirculation were collected at baseline,hemorrhagic shock （HS-0）,resuscitation 0 min （Res-0） and resuscitation 30 min （Res-30）.And side-stream dark field imaging （SDF） was employed to acquire the images of mesenteric microcirculation.Results No significant difference existed in the basic status between 4 groups.MAP decreased to around 40 mm Hg in all groups.MAP increased significantly after active fluid resuscitation （P 〈 0.05）.In addition to blank control group,total vascular density （TVD）,perfused vessel density （PVD）,proportion of perfused vessels （PPV） and microvascular flow index （MFI）significantly increased after active fluid resuscitation in the other three groups.TVD and PVD were significantly lower at Res-0 in VR than in RR （P 〈 0.05）.Conclusion After acute hemorrhagic shock,fluid resuscitation with whole blood and Ringer＇s solution improves systemic hemodynamics.And the combined regimen of whole blood and Ringer＇s solution is better at restoring mesenteric microcirculation.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第9期693-697,共5页
National Medical Journal of China
关键词
休克
出血性
复苏术
内脏循环
血液动力学
Shock,hemorrhagic
Resuscitation
Splanchnic circulation
Hemodynamics
