创伤性休克限制性液体复苏临界血压维持的实验研究

目的利用大鼠非控制性出血休克模型探讨创伤性休克早期不同复苏血压对休克复苏效果的影响。方法Sprague—Dawley（SD）大鼠56只，随机分为6组，每组12只。颈动脉放血＋断尾法复制非控制性出血休克模型，观察不同压力复苏对休克复苏效果的影响，观察指标包括血流动力学指标、血清肿瘤坏死因子α（（TNF—α）、红细胞压积、血pH、大鼠存活率及肺组织形态学。结果采用高压复苏（80mmHg，1mmHg=0．133kPa）的动物血红细胞压积低，血流动力学指标差，血pH、TNF—α低，肺组织细胞充血水肿，存活率下降，而采用低于60mmHg的血压复苏，动物存活率升高，血液稀释轻，血流动力学、血pH、TNF—α升高，肺组织形态学指标明显优于高压复苏组，但维持时间超过60min也不利于休克复苏。蛄论对创伤性休克，院前急救采用高压复苏会增加血液丢失，影响后期复苏效果；适当低压复苏（50-60mmHg）有利于保持动物的血流动力学稳定，改善后期复苏效果，提高存活率，但太低的输注压力及维持时间超过60min因影响组织灌流也不利于休克复苏。

Experimental study of maintaining critical pressure with limited fluid resuscitation in rats with trauma hemorrhage shock

Objective It is to investigate the effect of fluid resuscitation with different resuscitation pressure on resuscitation results in rats with early hemorrhage shock. Methods 56 Sprague - Dawley （SD） rats were randomly divided into 6 groups, every group including 12 rats, they were anesthetized by sodium pentobarbital. The models with hemorrhage shock caused by actice bleeding were established by drawing blood of carotid artery and cutting tails. The effects of different resuscitation pressure on resuscitation were observed by observing indexes including hemodynamics, TNF - α, HCT, pH, survival rates of rats and morphology of lung tissue. Results Lower HCT, pH and TNF - α, survival rates, bad hemodynamics indexes, and congestion edema cells in lung tissue could be found in the animals accepted high pressure fluid resuscitation （80 mmHg） , while better improvements of these indexes were found in the ones accepted lower pressure fluid resuscitation （ lower than 60 mmHg）, but maintain time Which was longer than 60min was not beneficial for shock resuscitation. Conclusion For trauma hemorrhage shock in pre-hospital stage, high pressure fluid resuscitation could increase blood loss and the resuscitation effect may be influenced. Lower pressure（50 -60 mmHg） could keep stability of hemodynamics so as to improve the results of resuscitation and the survival rates will be increased. But too lower pressure and longer time（ more than 60 minutes） was not helpful for the shock resuscitation.