创伤早期未控制性出血非手术疗法的实验研究

目的探讨延迟复苏、低容量液体复苏、脑垂体后叶素复苏对创伤早期重度未控制性失血性休克（UHS）复苏效果的影响。方法成年健康中华田园犬24只，股动脉放血，制作重度UHS模型。采用完全随机法随机分为A组（延迟复苏组）；B组（低容量液体复苏组）；C组（脑垂体后叶素组）。观察各组放血前即刻（TO）、达到目标血压时（T1）、实施三种复苏方法后1h（T2）、复苏平稳后2h（113）各时点的HR、MAP、CVP、血气分析及各组的出血量和72h存活率。结果1、2时点，A组的CVP、MAP明显低于B组和C组（P〈0．05），B组和C组间差异无统计学意义（P〉0．05）。B组和C组在B时点的血流动力学指标接近TO；在T2时点，A组的PaO：明显低于B组和C组（P〈0．05），A组中心静脉血乳酸（BL）和碱剩余（BE）均明显高于B组和C组（P〈0．05），B组BE明显高于C组（P〈0．05）。T3时点，B组和C组的BL和BE均组和明显高于1、0时点（P〈0．01），低于T1时点（P〈0．01）。三组间的Hot、出血量比较差异无统计学意义（P〉0．05）；A组72h内存活率明显低于B组和C组（P〈0．01）。结论低容量液体复苏能显著提高重度UHS时的存活率；小剂量垂体后叶素的复苏效果优于低容量液体复苏。

Experimental study on resuscitation from uncontrolled hemorrhagic shock during early period of trauma

Objective To study the effects of delayed resuscitation, limited fluid resuscitation and pituitrin resuscitation on uncon- trolled hemorrhagic shock during early period of trauma. Methods Uncontrolled hemorrhagic shock was produced by exsanguina- tion from arteria cruralis in 24 healthy clogs which were then randomized into three groups （ n = 8/group） , i.e. Group A （ delayed resuscitation）, Group B （limited fluid resuscitation）, Group C （pituitrin resuscitation）. Heart rate （HR）, mean artery pressure （MAP） and central venous pressure （CVP） , as well as blood gas analysis, were monitored at the time point of TO （before exsan- guination） , T1 （ goal blood pressure achieved） , T2 （ 1 hour after T1 ） and T3 （ 2 hours after T2）. Blood loss and survival after 72 hours were observed. Results At T2,CVP and MAP in Group A were significantly lower than that in Group B and in Group C （P 〈0.05）. At T3, the hemodynamic indexes in Group B and Group C were close to that at TO. At T2, PaO2 in Group A was significantly lower than that in Group B and Group C （P 〈 0.05）. BL and base excess （BE） in Group A were significantly higher than that in Group B and Group C （P 〈 0.05）. BE in Group B was significantly higher than that in Group C （P 〈 0.05 ）. At T3, BL and BE in Group B and Group C were significantly higher than that at TO （ P 〈 0.01 ） , but significantly lower than that at T1 （ P 〈 0.01 ）. Among the three groups there were no significant differences in hematocrit （Hct） and blood loss （P 〉0.05）. Survival in Group A was significantly lower than that in Group B and Group C （ P 〈 0.01 ）. Conclusion In serious uncontrolled hemorrhagic shock, limited fluid resuscitation significantly improves survival. Pituitrin is more effective than limited fluid in serious uncontrolled hemor- rhagic shock.