【摘要】：目的： 研究早期進行限制性液體復蘇對出血未控制的創(chuàng)傷性休克的治療效果及機制。 方法： 本實驗采用控制性頸動脈放血法建立出血未控制性休克兔模型,具體方法如下： (1)新西蘭雄性兔42只,隨機分為3組。每組14只：無液體復蘇組(對照組)、小劑量液體復蘇組、大劑量液體復蘇組。 (2)動態(tài)觀察休克前后及補液治療后1h,2h,3h,4h兔的MAP及各項實驗室指標。 (3)統計各組休克后4h病死率情況,統計分析比較各時間段MAP及各項實驗室指標數據。 (4)HE染色后在電子顯微鏡下觀察并比較心、肺、肝、腎組織的病理變化。 結果： (1)無液體復蘇組、小劑量液體復蘇組、大劑量液體復蘇組4h病死率分別為71%、7%、36%,小劑量組顯著低于無補液組(P=0.001),大劑量組與無補液組相比差異無統計學意義,表明限制性液體復蘇可以降低病死率。 (2)小劑量液體復蘇組較大劑量組、無液體復蘇組相比,血液中的RBC下降明顯減少,有統計學意義(P0.05),而大劑量組RBC值與無液體復蘇組無差異(P0.05)。表明限制性液體復蘇可以避免血液過度稀釋,增加組織氧供。 (3)比較各時間點乳酸、血鉀濃度,小劑量組較大劑量組、無液體復蘇組均有顯著下降(P0.05),表明限制性液體復蘇能減輕酸中毒,維持組織內環(huán)境穩(wěn)定。 (4)各組CK-MB、肌酐濃度,小劑量組較大劑量組、無液體復蘇組均有顯著下降(P0.05),表明限制性液體復蘇可以維持各器官功能的穩(wěn)定。 (5)病理結果顯示：各實驗組存活動物心、肺、肝、腎都有一定程度病理損傷,但是小劑量液體復蘇組損傷程度較未補液組、大劑量液體復蘇組較輕。表明限制性液體復蘇可以防止器官受到進一步的病理損傷。 結論： (1)對于非控制性出血性休克,在確定性手術止血之前進行低壓復蘇(MAP50-60mmHg)較之大劑量液體復蘇(MAP70-80mmHg)能顯著延長休克動物的存活時間,降低早期病死率； (2)限制性液體復蘇可以在一定程度上防止血液過度稀釋,從而增加血液的攜氧能力；減輕酸中毒,維持各器官功能,機體內環(huán)境及細胞代謝的穩(wěn)定；減輕休克液體復蘇對心、肺、肝、腎的病理損傷,更有利于預后。
[Abstract]:Objective: to study the therapeutic effect and mechanism of early restrictive fluid resuscitation on traumatic shock with uncontrolled hemorrhage. Methods: the rabbit model of uncontrolled hemorrhagic shock was established by controlled carotid artery bleeding. The methods were as follows: (1) 42 New Zealand male rabbits were randomly divided into 3 groups. There were 14 rats in each group: no fluid resuscitation group (control group), low dose fluid resuscitation group and high dose fluid resuscitation group. (2) the MAP and laboratory indexes of rabbits before and after shock were observed dynamically. (3) the death rate of 4 hours after shock was analyzed and compared with MAP and laboratory data. (4) the pathological changes of heart, lung, liver and kidney were observed and compared under electron microscope after HE staining. Results: (1) the fatality rate of fluid free resuscitation group, low dose fluid resuscitation group and high dose liquid resuscitation group was 71and 7360.The mortality of the low-dose group was significantly lower than that of the non-resuscitation group (P0. 001). There was no significant difference between the high dose group and the non-rehydration group, indicating that restricted fluid resuscitation could reduce the mortality. (2) the decrease of RBC in blood was significantly decreased in the small dose fluid resuscitation group and the non-liquid resuscitation group (P0.05), but the RBC value in the high-dose group was not different from that in the non-liquid resuscitation group (P0.05). Restrictive fluid resuscitation can avoid excessive hemodilution and increase tissue oxygen supply. (3) compared the concentration of lactic acid and potassium in blood at different time points, the concentration of lactic acid and potassium in small dose group and non-liquid resuscitation group were significantly decreased (P0.05), which indicated that restrictive fluid resuscitation could alleviate acidosis and maintain the stability of tissue environment. (4) CK-MB, creatinine concentration in each group, small dose group, large dose group, no fluid resuscitation group were significantly decreased (P0.05), indicating that restrictive fluid resuscitation can maintain the stability of organ function. (5) the pathological results showed that the heart, lung, liver and kidney of all experimental groups were damaged to some extent, but the injury degree of the small dose fluid resuscitation group was lower than that of the non-resuscitation group, and the high dose liquid resuscitation group was lighter. This suggests that restricted fluid resuscitation can prevent further pathological damage to organs. Conclusion: (1) for uncontrolled hemorrhagic shock, hypobaric resuscitation (MAP50-60mmHg) before definitive operation can significantly prolong the survival time of shock animals compared with high-dose fluid resuscitation (MAP70-80mmHg). Reducing early mortality; (2) restrictive fluid resuscitation can prevent excessive hemodilution to a certain extent, increase the oxygen carrying capacity of blood, reduce acidosis, maintain the function of various organs, and stabilize the environment and cell metabolism of the body. Reducing the pathological injury of heart, lung, liver and kidney caused by shock fluid resuscitation is more favorable for prognosis.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R459.7

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本文編號：2344327