目的探讨不同液体复苏对院前抢救创伤非控制出血性休克的影响。方法选择创伤非控制出血性休克237例，其中A组117例，2010-01-2011-10期间，采用限制性液体复苏行院前抢救；B组120例，选取既往患者，当时采用充分液体复苏行院前抢救。比...目的探讨不同液体复苏对院前抢救创伤非控制出血性休克的影响。方法选择创伤非控制出血性休克237例，其中A组117例，2010-01-2011-10期间，采用限制性液体复苏行院前抢救；B组120例，选取既往患者，当时采用充分液体复苏行院前抢救。比较两组输液量，病死率及并发症情况。结果院前急救时，与B组比较，限制性液体复苏组（A组）输液量少，[（650±310）mL vs （2580±720）mL]，病死率低（21．37％vs34．99％），凝血酶原时间（胛）短[（11．17±1．5）SVS（16．78±1．96）s]，并发症[如急性。肾衰竭（ARF）、弥散性血管内凝血（DIC）、成人呼吸窘迫综合征（ARDS）及多脏器功能障碍综合征（MODS）等]发生率合计低（16．30％VS37．18％），两组差异均有统计学意义（P〈0．05）。结论院前急救采用限制性液体复苏能减少输液量，降低病死率，存活者并发症发生率低，适宜临床救治。展开更多
Objective To study the effects of hypotensive resuscitation and larger volume fluid resuscitation on uncontrolled hemorrhagic shock and survival in rats with a standardized massive splenic injury model（MSI）.Methods ...Objective To study the effects of hypotensive resuscitation and larger volume fluid resuscitation on uncontrolled hemorrhagic shock and survival in rats with a standardized massive splenic injury model（MSI）.Methods Following the MSI model,fifty Wistar rats were randomly and equally divided into five groups,group 1:sham-operated group,group 2: shock untreated group,group 3:normal MAP resuscitation group（during acute resuscitation phase MAP was kept at 80 mm Hg）,group 4:Hypotensive resuscitation group（during acute resuscitation phase MAP was kept at（60±5） mm Hg）,and group 5:larger volume fluid resuscitation with hypotensive resuscitation group(during acute resuscitation phase MAP was kept at（60±5） mm Hg,simultaneously infused SNP at 5 μg·kg-1·min-1).Results The mean survival time in group 1～5 was 180 min,73.50 min±8.04 min,114.30 min±31.33 min,146.70 min±28.07 min and 171.60 min±15.74 min respectively.Statistic significances were seen in each group（P<0.05）,except between group 1 and group 5（P=0.0671）.The amount of bleeding in group 2～5（during acute resuscitation phase） was 3.79 ml/kg±1.39 ml/kg、17.41 ml/kg±8.88 ml/kg、8.67 ml/kg±4.59 ml/kg and 10.33 ml/kg±4.31 ml/kg respectively.The loss of blood in group 3 was significantly more than other groups（P<0.05）.Group 4 and 5 enhanced the blood loss significantly compared with group 2（P<0.05）.The histopathologic of liver and renal showed that histopathologic injury is severe in group 3 compared with group 4,and histopathologic injury is not in evidence in group 5.Conclusion Hypotensive resuscitation and adding SNP at proper dose additionally could improve tissue metabolism and prolong survival time during hypotensive resuscitation from uncontrolled hemorrhagic shock.It is a more ideal resuscitation method compared with normal blood pressure resuscitation.展开更多
目的应用大鼠非控制性出血性休克模型,探讨精氨酸血管加压素(AVP)、去甲肾上腺素(NE)、多巴胺(DA)以及盐酸山莨菪碱(654-2)输注后对大鼠复苏效果的影响。方法通过断脾复制非控制性出血性大鼠休克模型,以乳酸林格液(LR)和羟乙基淀粉(HES)...目的应用大鼠非控制性出血性休克模型,探讨精氨酸血管加压素(AVP)、去甲肾上腺素(NE)、多巴胺(DA)以及盐酸山莨菪碱(654-2)输注后对大鼠复苏效果的影响。方法通过断脾复制非控制性出血性大鼠休克模型,以乳酸林格液(LR)和羟乙基淀粉(HES)(体积比2∶1)进行复苏,维持血压在50 mm Hg1 h,再以含不同药物包括AVP(0.4 u/kg)、NE(0.3μg/kg)、DA(0.4 mg/kg)和654-2(1 mg/kg)的2倍失血量LR进行治疗,观察其对非控制性出血性休克大鼠平均动脉压(MAP),左心室收缩压(LVSP),左心室压力上升或下降的最大速率(±dp/dt max)的影响,同时观察存活时间、存活率的变化。结果单纯LR可维持血压在80 mm Hg左右,输注NE和DA后,血压不能维持在80 mm Hg,AVP、654-2能较好的将血压维持在90 mm Hg水平。几种药物在输液末、输液1 h和输液2 h,LVSP都有不同程度的增加,以AVP和NE在输液末增加尤为显著,其次是654-2、DA和LR。输注AVP、654-2和DA后,±dp/dt max显著高于LR组,NE其次,LR对照组最低。输注AVP后,大鼠存活时间最长,为(6.92±2.27)h,与LR组(3.9±2.1)h相比,明显升高(P<0.01),输注654-2[(5.28±3.33)h]后动物存活时间较其他组长[NE为(4.6±1.55)h,DA为(3.05±3.32)h]。结论不同药物对非控制性出血性休克大鼠复苏效果存在明显差异,以AVP效果最好。展开更多
文摘目的探讨不同液体复苏对院前抢救创伤非控制出血性休克的影响。方法选择创伤非控制出血性休克237例，其中A组117例，2010-01-2011-10期间，采用限制性液体复苏行院前抢救；B组120例，选取既往患者，当时采用充分液体复苏行院前抢救。比较两组输液量，病死率及并发症情况。结果院前急救时，与B组比较，限制性液体复苏组（A组）输液量少，[（650±310）mL vs （2580±720）mL]，病死率低（21．37％vs34．99％），凝血酶原时间（胛）短[（11．17±1．5）SVS（16．78±1．96）s]，并发症[如急性。肾衰竭（ARF）、弥散性血管内凝血（DIC）、成人呼吸窘迫综合征（ARDS）及多脏器功能障碍综合征（MODS）等]发生率合计低（16．30％VS37．18％），两组差异均有统计学意义（P〈0．05）。结论院前急救采用限制性液体复苏能减少输液量，降低病死率，存活者并发症发生率低，适宜临床救治。
文摘Objective To study the effects of hypotensive resuscitation and larger volume fluid resuscitation on uncontrolled hemorrhagic shock and survival in rats with a standardized massive splenic injury model（MSI）.Methods Following the MSI model,fifty Wistar rats were randomly and equally divided into five groups,group 1:sham-operated group,group 2: shock untreated group,group 3:normal MAP resuscitation group（during acute resuscitation phase MAP was kept at 80 mm Hg）,group 4:Hypotensive resuscitation group（during acute resuscitation phase MAP was kept at（60±5） mm Hg）,and group 5:larger volume fluid resuscitation with hypotensive resuscitation group(during acute resuscitation phase MAP was kept at（60±5） mm Hg,simultaneously infused SNP at 5 μg·kg-1·min-1).Results The mean survival time in group 1～5 was 180 min,73.50 min±8.04 min,114.30 min±31.33 min,146.70 min±28.07 min and 171.60 min±15.74 min respectively.Statistic significances were seen in each group（P<0.05）,except between group 1 and group 5（P=0.0671）.The amount of bleeding in group 2～5（during acute resuscitation phase） was 3.79 ml/kg±1.39 ml/kg、17.41 ml/kg±8.88 ml/kg、8.67 ml/kg±4.59 ml/kg and 10.33 ml/kg±4.31 ml/kg respectively.The loss of blood in group 3 was significantly more than other groups（P<0.05）.Group 4 and 5 enhanced the blood loss significantly compared with group 2（P<0.05）.The histopathologic of liver and renal showed that histopathologic injury is severe in group 3 compared with group 4,and histopathologic injury is not in evidence in group 5.Conclusion Hypotensive resuscitation and adding SNP at proper dose additionally could improve tissue metabolism and prolong survival time during hypotensive resuscitation from uncontrolled hemorrhagic shock.It is a more ideal resuscitation method compared with normal blood pressure resuscitation.
文摘目的应用大鼠非控制性出血性休克模型,探讨精氨酸血管加压素(AVP)、去甲肾上腺素(NE)、多巴胺(DA)以及盐酸山莨菪碱(654-2)输注后对大鼠复苏效果的影响。方法通过断脾复制非控制性出血性大鼠休克模型,以乳酸林格液(LR)和羟乙基淀粉(HES)(体积比2∶1)进行复苏,维持血压在50 mm Hg1 h,再以含不同药物包括AVP(0.4 u/kg)、NE(0.3μg/kg)、DA(0.4 mg/kg)和654-2(1 mg/kg)的2倍失血量LR进行治疗,观察其对非控制性出血性休克大鼠平均动脉压(MAP),左心室收缩压(LVSP),左心室压力上升或下降的最大速率(±dp/dt max)的影响,同时观察存活时间、存活率的变化。结果单纯LR可维持血压在80 mm Hg左右,输注NE和DA后,血压不能维持在80 mm Hg,AVP、654-2能较好的将血压维持在90 mm Hg水平。几种药物在输液末、输液1 h和输液2 h,LVSP都有不同程度的增加,以AVP和NE在输液末增加尤为显著,其次是654-2、DA和LR。输注AVP、654-2和DA后,±dp/dt max显著高于LR组,NE其次,LR对照组最低。输注AVP后,大鼠存活时间最长,为(6.92±2.27)h,与LR组(3.9±2.1)h相比,明显升高(P<0.01),输注654-2[(5.28±3.33)h]后动物存活时间较其他组长[NE为(4.6±1.55)h,DA为(3.05±3.32)h]。结论不同药物对非控制性出血性休克大鼠复苏效果存在明显差异,以AVP效果最好。
