發(fā)布時間：2018-04-27 01:09

  本文選題：膿毒癥 + 液體復蘇��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:感染性休克液體復蘇的劑量一直以來都備受爭議。本文擬觀察內(nèi)皮細胞多糖包被在感染性休克動物模型液體復蘇過程中的相對變化并討論液體復蘇的劑量問題。方法:新西蘭大白兔20只,隨機分為膿毒癥組和對照組,膿毒癥組又分為低劑量組(30ml/Kg液體復蘇)、高劑量組(60ml/kg液體復蘇)和單純膿毒癥組(未予液體復蘇),每組5只。運用LPS方法制作膿毒癥兔模型,對照組給予耳緣靜脈注射同等劑量5%葡萄糖注射液。靜脈注射藥物(對照組為葡萄糖注射液)后2小時由左頸總動脈置管連接壓力換能器,通過生物信號采集處理系統(tǒng)連續(xù)監(jiān)測有創(chuàng)動脈血壓(ABP)、平均動脈壓(MAP)、心率(HR)、血氧飽和度(SPO2)。由右側頸內(nèi)靜脈留置導管給予中心靜脈補液及應用血管活性藥物。分別于造模后0h、3h、6h抽取頸內(nèi)動、靜脈血液測定乳酸、血氣、血漿多配體聚糖(Syndecan-1)水平。監(jiān)測呼吸頻率、意識及目測動物暴露部分(口唇、耳緣動靜脈血管)微循環(huán)灌注情況。結果:(1)LPS后0h膿毒癥組與對照組相比,血壓明顯下降,心率及呼吸頻率增快。乳酸值:膿毒癥組㧐對照組(三組分別對比),結果具有統(tǒng)計學差異(P0.05下同)。組內(nèi)對比三組無明顯統(tǒng)計學差異;中心靜脈血氧飽和度(SCVO2)組間及組內(nèi)對比結果與乳酸結果相一致。多配體聚糖(Syndecan-1):膿毒癥組㧐對照組,結果有統(tǒng)計學差異,組內(nèi)對比三組無明顯統(tǒng)計學差異。(2)LPS后1h液體復蘇完成,同時依據(jù)平均動脈壓調(diào)整去甲腎上腺素(MAP≥65mm Hg)。3h血樣本Syndecan-1濃度結果:膿毒癥組㧐對照組(三組分別對比),結果有統(tǒng)計學意義。組內(nèi)對比:單純膿毒癥組㧐高劑量組㧐低劑量組,結果具有統(tǒng)計學差異。(3)LPS后6h血樣本Syndecan-1濃度結果顯示,單純膿毒癥組樣本濃度最高,且均高于另外三組,結果具有統(tǒng)計學差異;高劑量組、低劑量組、對照組三組樣本濃度結果差異無統(tǒng)計學意義,但其濃度均值高劑量組㧐低劑量組㧐對照組。(4)組別內(nèi)前后自身對比:低劑量組Syndecan-1濃度在整個實驗過程中變化不明顯,其差異不存在統(tǒng)計學意義。高劑量組Syndecan-1濃度在整個實驗過程中變化明顯。整體趨勢呈現(xiàn)進行性增高趨勢,0h樣本濃度㧐3h樣本濃度㧐6h樣本濃度,其差異存在統(tǒng)計學意義。單純膿毒癥組Syndecan-1濃度前后變化明顯。整體趨勢呈現(xiàn)進行性增高趨勢,0h樣本濃度㧐3h樣本濃度㧐6h樣本濃度,但其0h與3h樣本濃度差異無統(tǒng)計學意義,其0h樣本濃度及3h樣本濃度與6h樣本濃度相比差異均存在統(tǒng)計學差異。對照組Syndecan-1濃度前后變化不明顯。但其6h血樣本濃度較0h及3h相比仍小幅度增高,其0h樣本濃度與3h樣本濃度差異無統(tǒng)計學意義,其0h樣本濃度及3h樣本濃度與6h樣本濃度相比差異均存在統(tǒng)計學差異。(5)排除時間因素,進行組別間Syndecan-1濃度析因分析結果顯示:單純膿毒癥組㧐高劑量組㧐低劑量組,結果具有統(tǒng)計學差異,其中低劑量組均值高于對照組,但結果無統(tǒng)計學差異。結論:對于感染性休克動物模型進行液體復蘇,運用多糖包被標志物等分子生物學指標結果證實,保守劑量的液體復蘇聯(lián)合血管活性藥可能可以減少其結構的脫落,對于感染性休克動物模型進行液體復蘇,運用多糖包被標志物等分子生物學指標結果證實,保守劑量的液體復蘇可能可以減少其結構的脫落,其結果可能對病人內(nèi)皮細胞的保護及血管通透性的改善有積極意義。
[Abstract]:Objective: the dose of fluid resuscitation in septic shock has always been controversial. This article is to observe the relative changes in the fluid resuscitation in the animal model of septic shock and discuss the dose problem of the fluid resuscitation. Methods: 20 New Zealand white rabbits were divided into sepsis group and control group, and the sepsis group was divided into two groups. For low dose group (30ml/Kg fluid resuscitation), high dose group (60ml/kg liquid resuscitation) and simple sepsis group (no fluid resuscitation), 5 rabbits in each group were made by LPS method. The control group was given the same dose of 5% Glucose Injection in the ear vein. The intravenous drug (the control group was Glucose Injection) was left in the left neck 2 hours after the intravenous injection. The blood pressure (ABP), mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SPO2) were continuously monitored through the biologic signal acquisition and processing system. The central venous rehydration and the application of vasoactive drugs were given by the right internal jugular vein catheter. The internal carotid artery and venous blood were extracted after the model, 0h, 3h, 6h, respectively. Liquid determination of lactic acid, blood gas, plasma multi ligand polysaccharide (Syndecan-1) level. Monitoring respiratory frequency, awareness and visual measurement of animal exposure part (lip, auricular vein) microcirculation perfusion. Results: (1) after LPS 0h sepsis group compared with the control group, the blood pressure decreased significantly, heart rate and respiratory rate increased rapidly. The lactic acid value: sepsis group? Control group (three The results were statistically different (P0.05 below). There was no significant difference between the three groups. The results of the central venous blood oxygen saturation (SCVO2) were in accordance with the results of lactic acid. The results were statistically different in the group of sepsis and in the group of sepsis. There was no significant difference between the three groups. Difference. (2) after LPS, 1H fluid resuscitation was completed and the Syndecan-1 concentration of norepinephrine (MAP > 65mm Hg).3h blood samples was adjusted according to the average arterial pressure. The results were statistically significant in the sepsis group? Control group (three groups respectively). The results were statistically significant in the group of simple sepsis, high dose group and low dose group, and the results were statistically different. (3) LPS The results of Syndecan-1 concentration in the post 6h blood samples showed that the concentration of samples in the simple sepsis group was the highest and higher than the other three groups. The results were statistically different. There was no statistical difference between the high dose group, low dose group and the control group, but the mean concentration of the high dose group, the low dose group, the control group, and the control group. (4) the group in the low dose group and the control group. Syndecan-1 concentration in low dose group was not obvious during the whole experiment, and the difference was not statistically significant. The concentration of Syndecan-1 in high dose group changed obviously during the whole experiment. The overall trend showed progressive trend, the concentration of 0h sample? 3H sample concentration? 6h sample concentration, the difference was statistically significant. Pure sepsis The change of Syndecan-1 concentration in the disease group was obvious. The overall trend showed progressive trend, 0h sample concentration, 3h sample concentration and 6h sample concentration, but there was no statistical difference between the concentration of 0h and 3H samples, and the difference of 0h sample concentration and 3H sample concentration compared with 6h sample concentration were statistically different. The Syndecan-1 concentration in the control group was changed before and after. The concentration of 6h blood samples was still slightly higher than that of 0h and 3h, and there was no statistical difference between the concentration of 0h samples and the concentration of 3H samples. There was a statistical difference between the concentration of 0h samples and the concentration of 3H samples and the concentration of 6h samples. (5) the exclusion time factor and the result of the concentration analysis of Syndecan-1 concentration among the groups showed: single The results were statistically different in the high dose group, the high dose group and the low dose group, of which the low dose group was higher than the control group, but the results were not statistically significant. Conclusion: the liquid resuscitation in the animal model of septic shock and the results of molecular biologic indexes, such as the biomarker of polysaccharide envelope, were confirmed, and the conservative dose of liquid resuscitation combined with blood. The active drug may reduce the loss of its structure, the fluid resuscitation in the animal model of septic shock, and the results of molecular biological indicators, such as the biomarker of the polysaccharide package, confirm that the conservative dose of liquid recovery may reduce the loss of its structure, which may result in the protection of the endothelial cells of the patients and the alteration of the vascular permeability. Good is positive.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R459.7

【參考文獻】

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1 魯衛(wèi)華;陳群;袁荊;金孝\，

本文編號：1808490