本文關(guān)鍵詞：失血性心臟驟停兔模型構(gòu)建及其應(yīng)用研究　出處：《南方醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關(guān)文章： 失血性心臟驟停 動物模型 CPR 液體復蘇

【摘要】：研究目的為了更好地模擬嚴重失血致心臟驟停的病理生理過程及其治療經(jīng)過,并對心肺復蘇與液體復蘇在失血性心臟驟停中的應(yīng)用,本課題組實驗構(gòu)建失血性心臟驟停兔模型并對其進行探索。研究方法(1)選擇27只新西蘭兔分為假手術(shù)組(A組,不做處理)、未控制組(B,單純放血)、復蘇組(C組,放血與復蘇)。B、C組經(jīng)動靜脈放血約放出50%的全身血量,達到心臟驟停后維持狀態(tài)15min,隨后采用乳酸林格液和全血回輸復蘇。各時相點采動脈血測血氣分析并統(tǒng)計輸液量、失血量及6h存活率,處死后進行腎臟和心肌組織病理切片;(2)選擇12只新西蘭兔分為單純液體復蘇(A組)和液體復蘇組+CPR組(B組),構(gòu)建失血性心臟驟停模型后按相應(yīng)方式復蘇,各時相點采動脈血測血氣分析并統(tǒng)計輸液量、失血量、復蘇率及6h存活率,處死后行腎臟和心肌組織病理切片。研究結(jié)果(1)建模成功時B、C組血壓顯著降低,C組MAP下降至(14.5±5.3)mmHg。復蘇30 min C組MAP為(69.75±14.37)mmHg。在復蘇5 min時C組pH值、PaC02、Hct、Na+、C1-、Hb、實際碳酸氫鹽(AB)、標準碳酸氫鹽(SB)、實際堿剩余(ABE)、標準堿剩余(SBE)顯著降低,K+、乳酸水平顯著升高(與Omin比較:P均0.01);在復蘇25 min,僅K+恢復0 min水平,而AB、SB、SBE、ABE與乳酸均低于0 min水平(P均0.05);肌細胞HE染色示:C兩組心肌細胞界限不清、排列紊亂的現(xiàn)象較B組輕,心肌組織細胞缺氧受損改變較輕,心肌細胞水腫、壞死較輕,細胞間隙稍增寬。腎臟HE染色示:B、C組腎小管上皮細胞均存在玻璃樣改變和壞死,大量炎性細胞浸潤,C組亦可見更明顯空泡狀變性。(2)復蘇5min、復蘇10min、復蘇15min、和復蘇30min時間點兩組對比均有差異(P＜0.01),復蘇60min時A組MAP為(84.6±4.34)mmHg,B組MAP數(shù)值為(87.8±5.26),兩者比較無統(tǒng)計學差異(P0.05)。血氣結(jié)果中,復蘇5min時A組PaC02數(shù)值為(41.76±1.28),B組為(50.72±6.03),兩者對比有統(tǒng)計學差異(P＜0.05),余Hct、Na+、C1-、乳酸、Hb、AB、SB、ABE、SBE K+均無差異(P均0.05)。兩組各有一只兔子未復蘇成功,搶救成功率為83.7%,其中A、B組各有2只兔子并未堅持到所規(guī)定的6h時間限定,其6h最終存活率為60%。研究結(jié)論(1)通過動靜脈聯(lián)合放血構(gòu)建的模型穩(wěn)定性和可重復性高,適用于失血性心臟驟停的研究;(2)CPR聯(lián)合液體復蘇搶救與單純液體復蘇搶救在搶救成功率和生存率上在6h觀察期內(nèi)并無差異,唯一的優(yōu)勢是聯(lián)合CPR能以更快的速度達到ROSC。
[Abstract]:Objective to simulate the pathophysiological process and treatment of cardiac arrest caused by severe blood loss, and to evaluate the application of cardiopulmonary resuscitation and fluid resuscitation in hemorrhagic cardiac arrest. In this study, we constructed a rabbit model of hemorrhagic cardiac arrest and explored it. Methods: 27 New Zealand rabbits were divided into sham-operation group (group A) and control group (group B). Bloodletting alone, resuscitation group C, bloodletting and resuscitation group C bleeding and resuscitation group released about 50% whole body blood volume through arteriovenous bleeding, reaching the state of 15 minutes after cardiac arrest. Ringer lactate solution and whole blood transfusion were used for resuscitation. Arterial blood gas was collected at each time point to analyze the transfusion volume, blood loss and 6 h survival rate. The renal and myocardial tissue sections were taken after death. (2) 12 New Zealand rabbits were divided into two groups: fluid resuscitation group (A) and fluid resuscitation group (CPR) group (group B). The hemorrhagic cardiac arrest model was established and resuscitated according to the corresponding mode. Arterial blood samples were collected at different time points for blood gas analysis and blood transfusion, blood loss, resuscitation rate and 6 h survival rate. Pathological sections of kidney and myocardium were taken after death. The blood pressure in group C was significantly decreased. The MAP of group C decreased to 14.5 鹵5.3 mm Hg.The MAP of group C was 69.75 鹵14.37 for 30 min of resuscitation. The pH value of group C was 5 min after resuscitation. PaC02HctNa-C1-Hb, actual bicarbonate, standard bicarbonate, standard bicarbonate SBE, actual alkali residual abe, standard base residual SBE) decreased significantly. K, lactic acid level increased significantly (compared with Omin, 0. 01%, P = 0. 01); After 25 minutes of resuscitation, only K recovered to 0 min level, while ABN SBE and lactic acid were both lower than 0 min level (P 0.05). The results of HE staining showed that the boundary of cardiomyocytes in the two groups was not clear, the phenomenon of arrangement disorder was lighter than that in group B, the changes of hypoxia injury of myocardial tissue cells were lighter, the myocardial cells were edema and necrosis. The renal HE staining showed that there were glass like changes and necrosis in tubular epithelial cells in group C, and a large number of inflammatory cells were infiltrated. In group C, there were more obvious vacuolar denaturation at 5 min, resuscitation at 10 min, resuscitation at 15 min, and 30 min resuscitation (P < 0.01). At 60 minutes after resuscitation, the MAP of group A was 84.6 鹵4.34mm HgCU B, the MAP value of group B was 87.8 鹵5.26). There was no statistical difference between the two groups (P 0.05). The PaC02 value of group A was 41.76 鹵1.28 and that of group B was 50.72 鹵6.03 at 5 minutes after resuscitation. There was a significant difference between the two groups (P < 0.05), and there was no significant difference between the two groups (P < 0.05), and there was a significant difference between the two groups (P < 0.05). There was no difference in SBE K between two groups (P < 0.05). One rabbit in each group was not resuscitated and the successful rate of rescue was 83.7% (A). Two rabbits in group B did not adhere to the prescribed time limit of 6 hours, and the final survival rate was 60 hours. Conclusion 1) the model constructed by combined arteriovenous bleeding has high stability and reproducibility. Suitable for the study of hemorrhagic cardiac arrest; There was no difference in the survival rate and survival rate between CPR combined with fluid resuscitation and pure fluid resuscitation during the 6-hour observation period. The only advantage is that the combined CPR can reach Ros faster.
【學位授予單位】：南方醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R459.7;R-332

【參考文獻】

相關(guān)期刊論文 前5條

1 蔣守銀;巴立;楊儉新;趙小綱;張茂;干建新;;多發(fā)傷合并未控制性失血性休克模型的建立[J];中華創(chuàng)傷雜志;2013年01期

2 王振杰;鄭士友;王飛;陳前芬;;活動性出血休克家兔的限制性液體復蘇[J];中華急診醫(yī)學雜志;2009年02期

3 李濤;劉良明;刁有芳;廖自福;范小青;陳鳳;;幾種不同液體復蘇失血性休克大鼠的適宜量研究[J];第三軍醫(yī)大學學報;2008年03期

4 劉海燕;胡維信;裴輝;劉保池;;創(chuàng)傷性休克的液體復蘇與堿缺失監(jiān)測[J];中國現(xiàn)代醫(yī)生;2007年24期

5 錢遠宇;孟慶義;黃先勇;杜捷夫;計達;武建軍;;急診復蘇患者呼吸心跳停止前高危征象調(diào)查研究[J];中國急救醫(yī)學;2006年10期

，

本文編號：1416928