不同液体对急性呼吸窘迫综合征绵羊血流动力学和血管外肺水的影响

目的:探讨贺斯(HES)和林格液对急性呼吸窘迫综合征(ARDS)绵羊血流动力学和血管外肺水(EVLW)变化的影响.方法:利用内毒素静脉注射复制绵羊ARDS模型,补充贺斯(A组)10 mL/kg和林格液(B组)20 mL/kg,分别记录模型时(0 h)、补液后1、2、3 h的心率(HR)、心输出量(CO)、胸腔内血容量(ITBV)、心脏舒张末期容积(GEDV)以及EVLW的变化,并观察不同液体对上述指标的影响.结果:两组HR在模型成功0 min明显升高,补液后下降,两组间无明显差异;补液后A组CO、ITBV升高明显大于B组;两组间各时点平均动脉压(MAP)、中心静脉压(CVP)、肺动脉楔压(PAWP)均无显著差异.两组EVLW成模后均明显升高,补液后2、3 h B组EVLW明显高于A组.结论:HES对血流动力学的影响优于林格液,且不明显增加EVLW和肺水肿程度.

Effect of Different Solution on Hemodynamics and Extravascular Lung Water in Sheep with Acute Respiratory Distress Syndrome

Objective:To investigate the effect of 6% hydroethyl starch and lactate Ringer's solution on hemodynamics and extravascular lung water(EVLW) in sheep with acute respiratory distress syndrome(ARDS). Methods: Eighteen sheep with ARDS were induced by lipopolysaccharides. Each sheep was received fluid infusion with 6% hydroethyl starch (10 mL/kg)and Ringer's solution(20 mL/kg). Heart rate(HR), cardiac output (CO), intrathoracic blood volume (ITBV), global end-diastolic volume (GEDV), and EVLW were measured at 0, 1, 2, 3 h after fluid infusion. Results: HR increased significantly at basic values (0 h), decreased significantly after fluid loading, Both CO and ITBV in group A increased significantly after fluid loading more than those in group B. Mean arterial pressure(MAP), central venous pressure (CVP), pulmonary artery wedge pressure (PAWP) had no significant difference in the groups. EVLW increased significantly after basic values in the groups, and EVLW in group B increased significantly at 2, 3 h after fluid loading more than those in group A. Conclusions: 6% hydroethyl starchis is more effective in plasma expansion than Ringer's solution, did not significantly raise EVLW, did not significantly raise degree of pulmonary edema.