發(fā)布時(shí)間：2018-05-17 00:30

  本文選題：兔 + 失血性休克　； 參考：《第四軍醫(yī)大學(xué)》2015年碩士論文

【摘要】：目的探討小劑量不同濃度高滲鹽水(4.5%與7.5%)對非控制性失血性休克家兔早期液體復(fù)蘇效果的影響。方法將實(shí)驗(yàn)家兔隨機(jī)分為5組:假手術(shù)組(SHAM組)、休克未治療組(SWT組)、生理鹽水復(fù)蘇組(NS組)、4.5%鹽水復(fù)蘇組(4.5%組)和7.5%鹽水復(fù)蘇組(7.5%組),建立非控制性失血性休克家兔模型,在設(shè)定時(shí)間內(nèi),采用預(yù)定方案進(jìn)行液體復(fù)蘇,家兔實(shí)驗(yàn)途中若有死亡,補(bǔ)充以保證每組有效家兔數(shù)量為8只。在實(shí)驗(yàn)0min、30min、60min以及90min監(jiān)測以下指標(biāo):1.血流動(dòng)力學(xué)指標(biāo)(LVSP、±dp/dtmax、CVP、HR),由BL-420F生物信號采集系統(tǒng)監(jiān)測所得。2.腎臟功能監(jiān)測,在0min、30min、60min以及90min由股動(dòng)脈插管抽取2ml動(dòng)脈血,3000rpm離心15min后留取血清,試劑盒測BUN以及Cr含量。3.實(shí)驗(yàn)結(jié)束后統(tǒng)計(jì)出血量與輸液量,空氣栓塞處死家兔并留取心、肺、腎組織標(biāo)本做HE染色切片。結(jié)果1.各組家兔在月齡、基礎(chǔ)體重以及初始平均動(dòng)脈壓分別經(jīng)單因素方差分析證實(shí)差異無統(tǒng)計(jì)學(xué)意義(P0.05),各組之間均衡性較好。2.急性失血操作對家兔血流動(dòng)力學(xué)指標(biāo)以及腎臟功能的影響急性失血操作后,SWT組、NS組、4.5%組以及7.5%組家兔LVSP、±dp/dtmax、CVP均有顯著下降,并在15min時(shí)達(dá)到最低,30min時(shí),SWT組、NS組、4.5%組以及7.5%組LVSP、±dp/dtmax、CVP之間兩兩比較差異沒有統(tǒng)計(jì)學(xué)意義,但是均明顯低于SHAM組(P0.05);血清BUN、Cr均明顯上升,四組之間兩兩比較差異沒有統(tǒng)計(jì)學(xué)意義,并明顯高于SHAM組(P0.05);HR在實(shí)驗(yàn)過程中變化不明顯。3.液體復(fù)蘇對各組家兔血流動(dòng)力學(xué)指標(biāo)以及腎臟功能的影響給予液體復(fù)蘇后,NS組、4.5%組、7.5%組LVSP、±dp/dtmax、CVP均有不同程度的上升,并明顯高于SWT組(P0.05);NS組、4.5%組與7.5%組BUN、Cr在液體復(fù)蘇后均有下降趨勢,并顯著低于SWT組(P0.05)。NS組、4.5%組、7.5%組三組之間相比,7.5%組以及4.5%組家兔LVSP、±dp/dtmax的改善要明顯優(yōu)于NS組(P0.05);7.5%組BUN、Cr明顯低于NS組(P0.05),4.5%組與NS組、4.5%組與7.5%組之間BUN、Cr比較差異沒有統(tǒng)計(jì)學(xué)意義;三組之間CVP差異沒有統(tǒng)計(jì)學(xué)意義(P0.05)。4.各組家兔輸液量以及繼續(xù)出血量的比較NS組、4.5%組與7.5%組三組各時(shí)間段輸液量比較差異沒有統(tǒng)計(jì)學(xué)意義,但是7.5%組總輸液量明顯低于NS組(NS組=72.13±9.46ml,4.5%組=57.00±15.49ml,7.5%組=52.00±17.81ml);NS組、4.5%組與7.5%組液體輸入后會(huì)增加繼續(xù)出血量,其中NS組最高(6.15±0.56ml),7.5%組最低(4.89±0.34ml),但是三組之間差異沒有統(tǒng)計(jì)學(xué)意義。5.HE染色結(jié)果高倍顯微鏡下觀察,SHAM組心肺腎組織病理切片正常,SWT組各器官損傷較重,NS組、4.5%組、7.5%組病理切片略有改變但是要輕于SWT組,NS組、4.5%組、7.5%組三組之間各器官病理切片改變差異不明顯。結(jié)論1.通過股動(dòng)脈抽血方法可以成功建立失血性休克家兔模型,可以比較穩(wěn)定地模擬失血性休克傷員傷后狀態(tài)。2.液體復(fù)蘇可以有效改善失血性休克后血流動(dòng)力學(xué)指標(biāo)以及腎臟功能指標(biāo)。3.高滲鹽溶液對于失血性休克的救治效果要優(yōu)于生理鹽水。4.與4.5%高滲鹽溶液相比,7.5%高滲鹽溶液在失血性休克家兔中的救治效果更優(yōu)。
[Abstract]:Objective to investigate the effect of small dose of hypertonic saline (4.5% and 7.5%) on the effect of early fluid resuscitation in rabbits with non controlled hemorrhagic shock. Methods the experimental rabbits were randomly divided into 5 groups: sham operation group (group SHAM), shock untreated group (group SWT), saline resuscitation group (group NS), 4.5% saline resuscitation group (4.5% groups) and 7.5% saline resuscitation group (7.5%) A rabbit model of non controlled hemorrhagic shock was established. In the setting time, a predetermined solution was used to resuscitate the liquid. If there were death in the course of the rabbit, the number of effective rabbits in each group was 8. The following indexes were monitored in experimental 0min, 30min, 60min and 90min: 1. hemodynamic indexes (LVSP, + dp/dtmax, CVP, HR), and BL-420F 0min, 30min, 60min, and 90min were extracted from the arterial blood of the femoral artery, and the serum was extracted from the femoral artery intubation, 3000rpm centrifuged 15min and the serum were collected at the end of the 3000rpm centrifuge 15min. The amount of hemorrhage and the amount of transfusion were measured after the.3. experiment at the end of the Cr content, and the rabbits were killed and the specimens of the lungs and kidneys were stained with.2.. Results 1. each group of rabbits at the age of month, basal body weight and initial mean arterial pressure showed no significant difference (P0.05) respectively. The balance between each group was better than that of.2. acute blood loss operation on hemodynamic index and renal function in rabbits, group SWT, group NS, and group NS. And 7.5% groups of rabbits LVSP, + dp/dtmax, CVP all decreased significantly, and reached the lowest in 15min, 30min, SWT group, NS group, 4.5% groups and 7.5% groups of LVSP, + dp/dtmax, CVP 22, the difference was not statistically significant, but all obviously lower than SHAM group (P0.05), blood clear, the 22 difference was not statistically significant difference between the four groups. Significance, and obviously higher than group SHAM (P0.05); HR during the experiment did not change obviously the effect of.3. liquid resuscitation on the hemodynamic index and renal function of each group, after the fluid resuscitation, NS group, 4.5% groups, 7.5% groups of LVSP, + dp/dtmax, CVP have different degrees up, and obviously higher than the SWT group (P0.05); NS group, 4.5% groups and 7.5% groups BUN. After the fluid resuscitation, there was a downward trend, and significantly lower than group SWT (P0.05).NS group, 4.5% groups, 7.5% groups of three groups, 7.5% and 4.5% groups of rabbits LVSP, the improvement of + dp/dtmax was significantly better than the NS group (P0.05); the 7.5% group BUN, Cr significantly lower than the NS group (P0.05), 4.5% groups and NS, 4.5% and 7.5% groups, there was no statistical difference The difference of CVP between the three groups was not statistically significant (P0.05) the infusion volume of rabbits in.4. groups and the comparison of the continuous bleeding volume in the group NS, the 4.5% group and the 7.5% group three groups had no significant difference in the infusion volume, but the total infusion volume of the 7.5% groups was significantly lower than that of the NS group (NS group = 72.13 + 9.46ml, 4.5% groups =57.00 + 15.49ml, 7.5% =52.00 + 17.81ml. NS group, group NS, 4.5% groups and 7.5% groups of liquid input will increase the amount of continuous bleeding, among which group NS is the highest (6.15 + 0.56ml), the 7.5% group is the lowest (4.89 + 0.34ml), but there is no statistically significant difference between the three groups. The pathological section of the group SHAM in the group of cardiopulmonary kidney is normal, the injury of each organ in the group SWT is heavier, NS, 4.5%, 7.5%. The pathological section of the group was slightly changed, but it should be lighter than the SWT group, group NS, 4.5% groups, and 7.5% groups and three groups, the difference of pathological sections of each organ was not obvious. Conclusion 1. can successfully establish a rabbit model of hemorrhagic shock through the femoral artery blood extraction. It can be more stable to simulate the recovery of.2. liquid in the state of the injured patients after injury. The hemodynamic index and renal function index.3. hypertonic salt solution for hemorrhagic shock after hemorrhagic shock is better than the saline.4. and 4.5% hypertonic salt solution, and the treatment effect of 7.5% hypertonic salt solution in hemorrhagic shock rabbits is better.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R459.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 周繼紅,朱佩芳,王正國,劉大維,寧可;高滲鹽液對離體灌流左心室舒縮功能的影響[J];創(chuàng)傷外科雜志;2000年01期

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本文編號：1899101