摘要
目的 评价不同液体容量复苏对失血性休克犬血管外肺水的影响。方法 杂种犬32只,雌雄不拘,随机分为4组：NS组、HES组、HS组和HHS组,每组8只,股动脉放血建立失血性休克模型后,各组分别静脉输注容积相当于3倍失血量的生理盐水、失血量等容积的6%羟乙基淀粉130/0．4溶液、7．5%氯化钠溶液6 ml/kg及7．5%氯化钠-6%羟乙基淀粉130/0．4溶液6 ml/kg行容量复苏。经右颈内静脉持续监测中心静脉压、右股动脉置入PiCCO导管监测平均动脉压、心脏指数、每搏输出量、体循环阻力指数、血管外肺水指数及全心舒张末期容量指数,记录放血之前（基础值）、失血性休克模型成功即刻、容量复苏开始后5、30、60、120及180min的上述指标。结果 （1）各组在失血性休克的早期复苏中均可改善血液动力学,HES组、HHS组、HS组和NS组血液动力学改善持续时间依次缩短;（2）复苏早期HS组与HHS组血管外肺水无增加,NS组明显增加,而HES组下降。结论 （1） 7．5%氯化钠溶液与7．5%氯化钠-6%羟乙基淀粉130/0．4溶液小容量液体复苏可有效恢复犬失血性休克早期血液动力学的稳定,且不增加休克后血管外肺水,7．5%氯化钠-6%羟乙基淀粉130/0．4溶液效果较好;（2）6%羟乙基淀粉130/0．4溶液用于犬失血性休克早期复苏不仅可以改善血液动力学,而且能防止复苏后肺水肿。
Objective To investigate the effects of 7.5% NaCl solution,7.5% NaCl-6% hydroxyethyl starch （ HES 130/0.4） solution, normal saline and 6 % HES 130/0.4 solution on extravascular lung water （EVLW） in the treatment of early stage of hemorrhagic shock. Methods Thirty-two mongrel dogs of either sex weighing 18- 22 kg were anesthetized with intramuscular 3% pentobarbital 15-20 mg/kg, tracheotomized, intubated and mechanically ventilated. Right internal jugular vein was cannulated for CVP monitoring. PiCCO catheter was inserted into right femoral artery for monitoring of BP, cardiac index, stroke volume, systemic vascular resistance index, EVLW index （EVLWI） and GEDVI. The dogs were bled into hemorrhage shock within 30 min, MAP was maintained at 45-55 mm Hg for 45 min. The animals were then randomly divided into 4 groups （ n = 8 each） ： group NS received normal saline 3 times the volume of blood removed; group HES received 6% HES 130/0.4 at the volume equal to the volume of blood withdrawn; group HS received 7.5% NaCl 6ml/kg and group HHS received 7,5% NaCl-6% HES 130/0.4 solution 6 ml/kg, Fluid resuscitation was completed in 15 mins, Hemodynamic variables and EVLWI were measured before shock （baseline）, at 45 min after hemorrhagic shock was induced and at 5, 30, 60, 120 and 180 min after fluid resuscitation, Results （ 1 ） Hemodynamics was greatly improved by volume resuscitation in all 4 groups and the duration of improvement in hemodynamics was longest in group HES and shortest in group NS, （2） 7.5% NaCl and 7.5% NaCl-6% HES 130/0.4 did not increase EVLWI; Normal saline significantly increased whereas HES 130/0.4 decreased EVLWI. Conclusion （1） Both 7.5% NaCl and 7.5% NaCl-6% HES 130/0.4 can improve the hemodynamics during early stage of hemorrhagic shock without increasing EVLW, and 7.5% NaCl-6% HES 130/0.4 is better than 7.5% NaCl. （2）6% HES 130/0.4 can not only improve the hemodynamics, but also prevent pulmonary edema during early stage of hemorrhagic shock.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第4期356-359,共4页
Chinese Journal of Anesthesiology
关键词
补液疗法
休克
出血性
血液动力学现象
血管外肺水
Fluid therapy
Shock, hemorrhagic
Hemodynamic phenomena
Extravascular lung water
