摘要
目的探讨碳酸氢钠林格液在创伤失血性休克兔液体复苏中的效果。方法采用Lamson's法制作创伤失血性休克兔模型。日本长耳大白兔30只随机(随机数字法)均分为3组:正常对照组(NC组)10只,乳酸钠林格液组(LRS组)10只,碳酸氢钠林格液组(BRS组)10只。在复苏期给予不同干预,NC组动物仅做颈动脉、股动脉插管及全身肝素化,未行击打及放血,LRS组经耳缘静脉回输全部失血及等量乳酸钠林格液,BRS组回输全部失血及等量碳酸氢钠林格液进行复苏。于休克前即基础期(T1)、休克后(T2)、复苏期末(T3)、复苏后2 h(T4)各时间点记录平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR),并采动脉血进行血气分析。分别于12、24、36、48 h记录各组实验动物死亡数量,并计算生存率。组间比较采用单因素方差分析,多重比较用LSD法,各组生存时间的比较采用Kaplan生存分析的统计方法。结果三组兔子月龄、体质量、基础血压相比较,差异无统计学意义(P>0.05)。经液体复苏后2 h,BRS组及LRS组实验动物的MAP、HR、乳酸及动脉血pH分别为(87.79±2.94)mmHg vs(79.24±3.81)mmHg(1 mmHg=0.133 kPa)、(191.9±16.8)次/min vs(211.3±15.6)次/min、(6.09±1.94)mmol/L vs(7.89±2.47)mmol/L、(7.31±0.04)vs(7.21±0.04),BRS组的复苏效果明显优于LRS组(均P<0.05);BRS组实验动物12、24、36、48 h存活率均高于LRS组(90%vs 80%、80%vs 60%、70%vs 50%、60%vs 30%),差异有统计学意义(均P<0.05),且BRS组比LRS组存活时间长。结论在创伤失血性休克兔液体复苏中,输注碳酸氢钠林格液可以明显降低血乳酸水平,维持机体酸碱平衡及血流动力学稳定,并且能够提高创伤失血性休克兔的存活率。
Objective To investigate the effect of sodium bicarbonated Ringer's solution on fluid resuscitation in rabbits with traumatic hemorrhagic shock.Methods The rabbit model of traumatic hemorrhagic shock was established by Lamson's method.All 30 Japanese white rabbits were randomly divided into three groups:the normal control group(NC group,n=10),the sodium lactate Ringer's solution group(LRS group,n=10),and the sodium bicarbonate Ringer's solution group(BRS group,n=10).In the resuscitation period,rabbits in the NC group received only carotid artery and femoral artery intubation and systemic heparinization,without beating or bleeding.Rabbits in the LRS group received all blood loss and the same amount of sodium lactate Ringer's solution through the ear vein,and rabbits in the BRS group received all blood loss and the same amount of sodium bicarbonate Ringer's solution for resuscitation.Mean arterial pressure(MAP)and heart rate(HR)were recorded at each time point before shock,namely basal stage(T1),end of shock(T2),end of resuscitation(T3)and 2 h after resuscitation(T4),and arterial blood was collected for blood gas analysis.The death rates of the experimental animals in each group were recorded at 12,24,36 and 48 h,respectively,and the survival rates were calculated.One-way analysis of variance was used for comparison between groups,LSD method was used for multi-group comparison,and Kaplan survival analysis was used for comparison of survival time of each group.Results There were no significant differences in age,body mass index and basal blood pressure among the three groups(P>0.05).After 2 h of fluid resuscitation,the improvement effect of the BRS group was significantly better than that of the LRS group(MAP:87.79±2.94 mmHg vs 79.24±3.81 mmHg;HR:191.9±16.8 times/min vs 211.3±15.6 times/min;lactic acid:6.09±1.94 mmol/L vs 7.89±2.47 mmol/L;arterial blood pH:7.31±0.04 vs 7.21±0.04,all P<0.05).The survival rates of experimental animals in the BRS group at 12,24,36 and 48 h were significantly higher than those of the LRS groups(90%vs 80%,80%vs 60%,70%vs 50%,60%vs 30%;all P<0.05),and the survival time of the BRS group was longer than that of the LRS group.Conclusions During the fluid resuscitation of rabbits with traumatic hemorrhagic shock,sodium bicarbonate Ringer's solution can significantly reduce the blood lactic acid level,maintain the acid-base balance and hemodynamic stability,and improve the survival rate of rabbits with traumatic hemorrhagic shock.
作者
李贺
尹冉
李申涛
宋凯
Li He;Yin Ran;Li Shentao;Song Kai(Department of Emergency Surgery,the Second Affiliated Hospital of Anhui Medical University,Hefei 230000,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2020年第5期656-660,共5页
Chinese Journal of Emergency Medicine
基金
安徽省医学会急诊临床研究项目(Ky2018024)。
关键词
创伤失血性休克
兔
乳酸
血流动力学
碳酸氢钠林格液
Traumatic hemorrhagic shock
Rabbits
Lactic acid
Haemodynamics
Sodium bicarbonate Ringer's solution
