【摘要】：目的制作野戰(zhàn)腹部血管損傷非控制性失血性休克(UHS)模型,探索在休克不同階段給予不同復(fù)蘇方案的治療效果。方法SD大鼠50只,左股動(dòng)、靜脈及左心室插管后開腹,其中42只于腹主動(dòng)脈中下段用25G針頭穿刺造成活動(dòng)性出血模擬UHS,32只造模成功。根據(jù)戰(zhàn)創(chuàng)傷實(shí)際,將動(dòng)物分為受傷早期、早期救助期、后期救治期及觀察期4個(gè)階段。大鼠隨機(jī)分為以下4組:對(duì)照組(n=10),不進(jìn)行治療;院內(nèi)治療組(n=11),早期不復(fù)蘇,后期救治期給予手術(shù)止血并輸入林格液維持血壓在90mmHg左右;分階段救治組(n=11),于早期救助期以1ml/(kg.min)的速度持續(xù)緩慢輸入林格液,后期救治期治療同院內(nèi)治療組;假手術(shù)組(n=8)。監(jiān)測(cè)大鼠平均動(dòng)脈壓(MAP)、中心靜脈壓(CVP)、血乳酸水平及肝腎功能等,并統(tǒng)計(jì)腹腔出血量及存活時(shí)間。結(jié)果血管損傷后15min對(duì)照組大鼠平均動(dòng)脈壓由94.7mmHg下降到28.9mmHg(P0.01),分階段救治組早期持續(xù)性液體復(fù)蘇后休克大鼠平均動(dòng)脈壓逐漸升高,但仍然未超過60mmHg。CVP的變化與MAP相似。對(duì)照組、院內(nèi)治療組傷后早期血乳酸水平、轉(zhuǎn)氨酶活性及肌酐水平即升高,而分階段救治組升高顯著延遲。對(duì)照組、院內(nèi)治療組、分階段救治組大鼠平均存活時(shí)間為分別為76、846、2480min,對(duì)照組大鼠均在24h內(nèi)死亡,院內(nèi)治療組及分階段救治組72h死亡率分別為72.7%和36.4%。結(jié)論采用以早期持續(xù)性緩慢液體復(fù)蘇為特征的分階段救治措施,雖然不能快速升高血壓及有效循環(huán)血量,但可有效抑制血乳酸水平的升高,維持器官功能,且不會(huì)顯著增加腹腔出血量,從而可延長(zhǎng)UHS動(dòng)物存活時(shí)間、提高存活率。
[Abstract]:Objective to establish an (UHS) model of uncontrolled hemorrhagic shock caused by abdominal vascular injury in the field, and to explore the effect of different resuscitation schemes in different stages of shock. Methods the left femoral artery, vein and left ventricle were intubated in 50 SD rats, 42 of them were operated on the middle and lower part of the abdominal aorta with 25G needle puncture to simulate the UHS,32. According to the actual situation of war trauma, the animals were divided into four stages: the early stage, the early period of rescue, the later period of rescue and the period of observation. Rats were randomly divided into the following four groups: control group (n = 10) without treatment, in-hospital treatment group (n = 11) with no resuscitation at early stage, operation hemostasis during later treatment period and infusion of ringer solution to maintain blood pressure at 90mmHg or so. 1ml/ (kg.min) was used to infuse Ringer's fluid slowly and continuously in the early relief period, and the treatment group was treated with the same hospital in the later period of treatment (n = 8), and the control group (n = 8) was given sham-operation group (n = 8). The mean arterial pressure (MAP),) central venous pressure (CVP),) blood lactate level and liver and kidney function were monitored and the intraperitoneal blood loss and survival time were counted. Results the mean arterial pressure in 15min control group decreased from 94.7mmHg to 28.9mmHg (P0.01) after vascular injury, and the mean arterial pressure increased gradually after early sustained fluid resuscitation in the treatment group. However, the change of 60mmHg.CVP was similar to that of MAP. In the control group, the level of lactic acid, the activity of transaminase and creatinine increased in the early posttraumatic period, but delayed in the treatment group. The average survival time of the rats in the control group, the in-hospital treatment group and the phased treatment group was 76.846U 2480 min, respectively. The rats in the control group died within 24 hours. The 72h mortality of the in-hospital treatment group and the phased treatment group were 72.7% and 36.4%, respectively. Conclusion although the early sustained slow fluid resuscitation can not raise blood pressure and effective circulation blood volume, it can effectively inhibit the increase of blood lactic acid level and maintain organ function. And no significant increase in the amount of intraperitoneal bleeding, which can prolong the survival time of UHS animals, improve the survival rate.
【作者單位】：
【分類號(hào)】：R82

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