左西孟旦与多巴酚丁胺治疗脓毒症心肌病疗效对比

目的 比较应用左西孟旦和多巴酚丁胺治疗脓毒症心肌病患者的临床效果.方法 回顾性分析福建省立医院2018年1月至2020年12月收治的66例脓毒症心肌病患者,按照治疗方法的不同分为多巴酚丁胺组(n=32)和左西孟旦组(n=34),分别在常规治疗的基础上应用多巴酚丁胺和左西孟旦.分析治疗前后2组患者的N末端B型利尿钠肽原(N-terminal pro-brain natriuretic peptide,NT-proBNP)、肌钙蛋白I、乳酸水平、氧合指数、住院时间、住院死亡率、去甲肾上腺素总剂量以及不良反应情况.结果 治疗前,两组患者的NT-proBNP、肌钙蛋白I、乳酸、氧合指数差异无统计学意义(P>0.05);治疗后,两组患者的NT-proBNP、乳酸、肌钙蛋白I水平比治疗前降低,氧合指数比治疗前升高(均P<0.05).治疗后,左西孟旦组患者的NT-proBNP、肌钙蛋白I、乳酸水平、住院时间和去甲肾上腺素总剂量比多巴酚丁胺组低,氧合指数比多巴酚丁胺组高(均P<0.05);与多巴酚丁胺组相比,左西孟旦组心律失常发生率下降,差异有统计学意义(P<0.05).两组死亡率差异无统计学意义(P>0.05).结论 左西孟旦与多巴酚丁胺相比,能更好地改善脓毒症心肌病患者的心功能,稳定血流动力学,减少住院时间,但无法降低住院死亡率.     

去甲肾上腺素联合多巴酚丁胺对感染性休克患者心室功能影响的研究

目的观察去甲肾上腺素（NE）、去甲肾上腺素联合多巴酚丁胺（NE＋Dobu）对感染性休克患者心室功能的影响。方法符合感染性休克诊断标准的17例患者经过积极的液体复苏后，随机应用血管活性药物，观察增加心排指数（CI）、体循环阻力指数（SVRI）、肺循环阻力指数（PVRI）、左室每搏功指数（LVSWI）、右室每搏功指数（RVSWI）的变化。结果去甲肾上腺素、去甲肾上腺素＋多巴酚丁胺都能提高血压，增加心排指数（CI）、体循环阻力指数（SVRI）、左室每搏功指数（LVSWI）、氧输送（DO2），与基础值比较差异有显著性意义（P〈0．05）；对降低PVRI、增加RVSWI去甲肾上腺素＋多巴酚丁胺比单独去甲肾上腺素明显，但差异没有统计学意义（P〉0．05）。结论多巴酚丁胺和去甲肾上腺素联合既能明显改善左心功能，对右心功能也有一定的改善作用，是治疗感染性休克患者理想的血管活性药。     

左西孟坦联合多巴酚丁胺治疗急性心力衰竭

目的观察左西孟坦联合多巴酚丁胺治疗急性心力衰竭的临床疗效。方法95例急性心力衰竭患者,NYHA分级Ⅳ级且左室射血分数（LVEF）〈40％,将其按治疗方法的不同分成治疗组及对照组。治疗组（n=47）予左西孟坦联合多巴酚丁胺治疗,对照组（n=48）予左西孟坦治疗,比较2组疗效、心功能及不良反应发生情况。结果治疗组总有效率高于对照组（78．7％比60．4％,P〈0．05）。治疗后,2组LVEF、中心静脉压（CVP）及每搏输出量（SV）较治疗前显著改善（P〈0．05）;且治疗组优于对照组（P〈O．05）。2组不良反应发生率差异无统计学意义（P=0．671）。结论左西孟坦联合多巴酚丁胺治疗急性心力衰竭疗效确切,患者的心功能改善较为明显,且不良反应并未明显增多。     

多巴酚丁胺联合环磷腺苷治疗老年心力衰竭疗效观察

目的探讨多巴酚丁胺联合环磷腺苷治疗老年心力衰竭的方法及疗效。方法将所选心力衰竭患者随机分为A、B、C三组,A组（33例）给予多巴酚丁胺针30mg加入5％葡萄糖注射液250ml中,以2．5～5．5μg／（kg·min）的速度静脉滴入,每日1次,环磷腺苷针80mg加入5％葡萄糖注射液250ml中静脉滴入,每日1次;B组（32例）予以洋地黄制剂、利尿剂及血管扩张剂;C组（33例）单用多巴酚丁胺治疗,方法、剂量、滴速与A组相同。治疗前后分别观察各组心功能、心率变化。结果应用多巴酚丁胺的A、C组,左室收缩功能及舒张功能均有改善,但以合用环磷腺苷者左室收缩功能改善较单用多巴酚丁胺及传统的洋地黄类、利尿剂及血管扩张剂均有显著改善。结论多巴酚丁胺联合环磷腺苷治疗老年心力衰竭疗效明显,较单用多巴酚丁胺及传统的治疗方法更佳。     

去甲肾上腺素联合多巴酚丁胺对感染性休克患者胃粘膜灌注的作用

目的：观察多巴胺（Dopa)、去甲肾上腺素（NE）、去甲肾上腺素联合多巴酚丁胺（NE＋Dobu）对感染性休克患者胃肠道灌注的影响。方法：符合感染性休克诊断标准的13例患者经过积极的液体复苏后，随机应用血管活性药物，观察胃粘膜内pH(pHi）、胃粘膜与动脉血二氧化碳分压差（△PCO2）的变化。结果：多巴胺、去甲肾上腺素，去甲肾上腺素＋多巴酚丁胺都能提高血压，增加心排指数（CI）、体循环阻力指数（SVRI）、左室每搏功指数（LVSWI）、氧输送（DO2），与基础值比较差异有显著性意义（P＜0．05）；但对胃pHi,△PCO2的改善去甲肾上腺素＋多巴酚丁胺比单独去甲肾上腺素明显，比多巴胺更好，差异有显著性意义（P＜0．05）。结论：多巴酚丁胺和去甲肾上腺素联合即能增加CI、SVRI、LVSWI、DO2，又能改善胃pHi, △PCO2，是治疗感染性休克患者理想的血管活性药。     

去甲肾上腺素联合多巴酚丁胺对感染性休克病人胃黏膜灌注的作用

目的　观察多巴胺、去甲肾上腺素、去甲肾上腺素联合多巴酚丁胺对感染性休克病人胃肠道灌注的影响。方法　符合感染性休克诊断标准的 13例病人经过积极的液体复苏后 ,随机应用血管活性药物 ,观察胃黏膜pHi、△PCO2 的变化。结果　多巴胺、去甲肾上腺素、多巴酚丁胺 +去甲肾上腺素都能提高血压 ,增加CI、SVRI、LVSWI、DO2 ,与基础值比较有显著性差异 ,P <0 0 5 ;但对胃pHi、△PCO2 的改善去甲肾上腺素 +多巴酚丁胺比单独去甲肾上腺素明显 ,比多巴胺更好 ,有显著性差异 ,P <0 0 5。结论　多巴酚丁胺和去甲肾上腺联合既能增加CI、SVRI、LVSWI、DO2 ,又能改善胃pHi、△PCO2 ,是治疗感染性休克病人理想的血管活性药     

去甲肾上腺素联合多巴酚丁胺对感染性休克病人肾功能的影响

目的　观察多巴胺、去甲肾上腺素、去甲肾上腺素联合多巴酚丁胺对感染性休克病人肾功能的影响。方法　符合感染性休克诊断标准的 15例病人经过积极的液体复苏后 ,随机应用血管活性药物 ,观察尿量、肌酐清除率 (CCr)、钠排泄分数 (FeNa)的变化。结果　多巴胺、去甲肾上腺素、多巴酚丁胺联合去甲肾上腺素都能提高血压 ,增加CI、SVRI、LVSWI,与基础值比较有显著性差异 ,P <0 0 5 ;但对肾功能的改善去甲肾上腺素联合多巴酚丁胺比单独去甲肾上腺素、多巴胺有显著性差异 ,P <0 0 5 ;多巴胺增加尿量、FeNa有显著性差异 ,P <0 0 5。结论　去甲肾上腺素联合多巴酚丁胺既能增加CI、SVRI、LVSWI ,又能改善肾功能 ,是治疗感染性休克病人理想的血管活性药。     

低剂量多巴酚丁胺负荷试验对急性心肌梗塞患者心率和血压的影响

对２７例初发急性心肌梗塞患者行低剂量多巴酚丁胺负荷超声心动图试验，并在试验前５ｍｉｎ及试验５ｍｉｎ监测其心率及血压。结果表明：低剂量多巴酚丁胺负荷超声心动图试验对心率和血压影响不显著（Ｐ〉０．０５），是诊断急性心肌梗塞一项较安全的负荷试验，对指导心肌梗塞患者的进一步治疗具有重要的临床参考价值。     

多巴酚丁胺试验对冠心病的诊断价值

多巴酚丁胺(DBT)用于冠心病的诊断,目前国内报道极少.为了探讨其对冠心病的诊断符合率,我们对18例心绞痛的病人进行了多巴酚丁胺心电图试验(D-ECG-T),现报告如下.     

多巴酚丁胺联用去甲肾上腺素和多巴胺对感染性休克绵羊内脏器官灌注的影响

目的 :观察多巴酚丁胺联用去甲肾上腺素和多巴胺对感染性休克绵羊内脏灌注的影响。方法 :静脉注射内毒素 (L PS)复制绵羊感染性休克模型 ,当收缩压下降至低于 90 .0 0 m m Hg(1m m Hg=0 .133k Pa)或较L PS注射前降低 39.75 m m Hg时记录血流动力学及肠黏膜 p H(p Hi)的基础值。 2 0只绵羊随机分为两组 ,分别静脉注射多巴酚丁胺加去甲肾上腺素和多巴胺 ,调整药物剂量 ,使平均动脉压升高到 90 .0 0 mm Hg,观察药物使用前 (基础值 )及用药后 1、2、3、4 h的血流动力学和内脏灌注指标 p Hi。结果 :在 L PS注射前和基础状态 ,多巴胺组与多巴酚丁胺 +去甲肾上腺素组的血流动力学、氧代谢和肠道 p Hi指标均无明显差异 ;与基础值相比 ,两组动物在用药后血压、心脏指数及氧输送明显升高。多巴胺组用药 4 h动脉乳酸浓度及 p Hi水平与基础值比较无明显改变 ;但动脉 p H值基础水平为 7.4 0± 0 .0 5 ,多巴胺应用 1h后显著降低至 7.2 6± 0 .0 6 (P<0 .0 5 )。应用多巴酚丁胺加去甲肾上腺素后 3和 4 h,动脉乳酸浓度分别为 (2 .3± 1.1) m mol/ L 和 (2 .1± 1.1) m mol/ L,均显著低于基础水平 (4 .0± 1.8) m mol/ L(P<0 .0 5 )。应用多巴酚丁胺加去甲肾上腺素前动物 p Hi为 7.19±0 .0 4 ,用药后 3h,p Hi明显升高到     

Comparative haemodynamic effects of dopamine and dobutamine in septic shock

Septic shock associated with depressed myocardial function generally requires the use of catecholamine. Currently dopamine is often selected. Dobutamine is a newly developed catecholamine which has been shown to be of value in severe cardiomyopathic disease. The aim of this work was to determine the most appropriate drug by comparing haemodynamic responses to dopamine and dobutamine in 19 studies carried out in 11 patients with septic shock and heart failure. Cardiac index increased similarly with dopamine and dobutamine (33%), as did stroke volume (respectively 26.4 and 25%). Arterial pressure increased by 17% with dopamine whereas it did not significantly change with dobutamine due to reduction in vascular resistance of 19%. Dobutamine decreased filling pressure, either right (14%) or left (28%) whilst they slightly but unsignificantly increased with dopamine. Pulmonary shunting increased more with dopamine (47%) than with dobutamine (16%), but PaO₂ remained constant with both. Since septic shock is characterized by lowered arterial pressure and vasodilatation it is concluded that effects of dopamine on capacitance and resistance vessels make this drug more suitable. In addition it selectively increases renal blood flow. Nevertheless dobutamine could be appropriate, in case of very high filling pressures, severe peripheral vasoconstriction, marked pulmonary shunting and in some cases where dopamine becomes ineffective.     

Systemic and microcirculatory effects of dobutamine in patients with septic shock

Purpose

The aim of this study was to characterize the cardiovascular responses to dobutamine and their predictors. Our hypotheses were that dobutamine mainly produces tachycardia and vasodilation and fails to improve the microcirculation of patients with septic shock.

Materials and Methods

Systemic hemodynamics and sublingual microcirculation were evaluated with dobutamine (0, 2.5, 5.0, and 10.0 μg kg^− 1 min^− 1) in 23 patients with septic shock.

Results

Dobutamine increased heart rate, cardiac index, and stroke volume index (SVI). Mean blood pressure was unchanged, and systemic vascular resistance decreased. Individual responses were heterogeneous. Stroke volume index increased in 52% of the patients. These patients showed lower changes in mean blood pressure (3 ± 16 mm Hg vs − 10 ± 6 mm Hg, P < .05) and higher increases in cardiac index (1.47 ± 0.93 L m^− 1 m^− 2 vs 0.20 ± 0.5 L m^− 1 m^− 2) than did nonresponders. Changes in SVI significantly correlated with echocardiographic left ventricular ejection fraction (r = 0.55). In the whole group, perfused capillary density remained unchanged (14.0 ± 4.3 mm/mm² vs 14.8 ± 3.7 mm/mm²), but improved if basal values were 12 mm/mm² or less (9.1 ± 4.3 mm/mm² vs 12.5 ± 4.8 mm/mm²).

Conclusions

Dobutamine produced variable hemodynamic effects. Systolic dysfunction was the only variable associated with increases in SVI. Finally, dobutamine only improved sublingual microcirculation when severe alterations were found at baseline.     

Effect of N-acetylcysteine (NAC) on acute lung injury and acute kidney injury in hemorrhagic shock

Aim of the study

N-acetylcysteine (NAC) has been investigated to attenuate organ injury in various experimental and clinical studies. However, results in hemorrhagic shock (HS) were controversial. We determined the effects of continuous administration of NAC on acute lung injury (ALI) and acute kidney injury (AKI) in HS model.

Methods

Twenty male Sprague-Dawley rats were used. Pressure controlled HS model defined by mean arterial pressure (MAP) 40 ± 2 mmHg for 90 min followed by resuscitation and observation was used. Rats (n = 10 per group) were randomized into 2 groups with NAC or dextrose. Intravenous NAC was given continuously from 15 min after induction of HS to the end of observation period (2 h). We measured serum IL-6, nitrite/nitrate concentration. NF-κB p65 DNA binding activity, expressions of cytoplasmic phosphorylated IκB-α (p-IκB-α) and IκB-α, malondialdehyde (MDA) and histopathological injury scores in lung and kidney were also evaluated.

Results

MAP did not show any difference during the study period. NAC decreased histopathologic scores in both lung and kidney. Lung and kidney MDA levels were significantly lower in the NAC group compared to control group. Serum nitrite/nitrate and IL-6 were also significantly lower in the NAC group. The levels of lung cytoplasmic p-IκB-α expression was mitigated by NAC, and NF-κB p65 DNA binding activity was also significantly decreased in the NAC group.

Conclusions

Continuous infusion of NAC attenuated inflammatory response and acute lung and kidney injury after hemorrhagic shock in rats.     

左西孟旦对脓毒性休克患者血流动力学及心功能的影响

目的探讨左西孟旦对脓毒性休克患者血流动力学及心功能的影响。方法采用前瞻性单中心随机对照研究方法,选择2011年6月至2013年10月河北医科大学第三医院重症医学科确诊为脓毒性休克患者,根据脓毒性休克指南进行液体复苏及给予血管活性药物,使用心脏超声评价心脏功能,将复苏后左室射血分数（LVEF）≤0.45的36例患者纳入本研究,并按照随机数字表法分为两组,每组18例。在常规治疗基础上,多巴酚丁胺组液体复苏后即持续静脉注射5μg·kg-1·min-1多巴酚丁胺48 h;左西孟旦组静脉注射5μg·kg-1·min-1多巴酚丁胺24 h后静脉注射左西孟旦0.2μg·kg-1·min-1连续24 h。治疗期间用脉搏指示连续心排血量（PiCCO）及超声评价血流动力学和心脏功能等。结果与多巴酚丁胺组比较,左西孟旦组治疗后每搏量指数（SVI）、心排血指数（CI）、左室每搏作功指数（LVSWI）均明显升高〔SVI（mL/m2）：39.8±5.4比37.5±4.5,t＝-2.762, P＝0.020;CI（L·min-1·m-2）：4.6±0.7比3.6±0.7,t＝-9.829,P＝0.000;LVSWI（kg·min-1·m-2）：33.7±2.4比28.2±1.2,t＝-6.307,P＝0.000〕,中心静脉压（CVP）、胸腔内血容量指数（ITBVI）、血管外肺水指数（EVLWI）均明显降低〔CVP（mmHg,1 mmHg＝0.133 kPa）：8.2±0.9比12.1±0.8,t＝3.928,P＝0.002;ITBVI（mL/m2）：820±42比978±69,t＝9.472,P＝0.000;EVLWI（mL/kg）：6.1±1.6比8.9±1.7,t＝4.467,P＝0.001〕。心脏超声显示,与多巴酚丁胺组比较,左西孟旦组左室收缩期末容积指数（LVESI）和左室舒张期末容积指数（LVEDI）均明显缩小〔LVESI（mL/m2）：32.7±9.2比48.2±13.4,t＝0.882,P＝0.000;LVEDI（mL/m2）：61.7±11.4比78.6±13.6,t＝2.453,P＝0.032〕,LVEF明显增高（0.463±0.068比0.383±0.085,t＝-2.439,P＝0.035）。左西孟旦还可以降低乳酸水平（mmol/L：3.4±1.1比5.2±1.2,t＝3.346,P＝0.007）,提高肌酐清除率（mL/min：73.2±13.5比47.6±11.8, t＝-4.079,P＝0.002）,增加24 h尿量（mL：2213.4±354.0比1533.8±402.0,t＝6.342,P＝0.000）,增加24 h累积液体入量（mL：5746.6±420.0比4156.7±215.0,t＝7.126,P＝0.000）。而两组去甲肾上腺素总用量、重症监护病房（ICU）病死率及28 d病死率均无明显差异。结论左西孟旦可以提高心脏射血功能,降低心脏前负荷、胸内血容量和血管外肺水,改善脓毒性休克患者心脏功能及全身血流动力学指标。     

不同百草枯中毒剂量对兔肺损伤程度的影响

目的研究不同百草枯(PQ)中毒剂量对兔中毒性急性肺损伤(ALI)及肺纤维化(PF)程度的影响。方法将36只成年新西兰大白兔随机分成3组(A、B、C组),每组12只,分别经胃管灌入8mg/kg(A组)、16mg/kg(B组)和32mg/kg(C组)不同剂量的PQ。7d后处死动物,取肺组织行HE染色、ALI评分并行Masson染色以鉴定PF程度。结果 A组ALI评分为(8.33±1.03)分,明显低于B组([9.83±1.17)分,P=0.047)]和C组([11.50±1.38)分,P0.01],B组较C组差异也有统计学意义(P=0.03);A组PF程度为(31.09±2.05)%,明显低于B组([34.37±1.62)%,P=0.002]和C组([36.54±0.44)%,P0.01],B组较C组差异也有统计学意义(P=0.026)。Pearson相关分析显示不同剂量的PQ与ALI、PF程度明显相关。结论随中毒剂量的增大,兔急性肺损伤及PF的病理改变越显著。PQ剂量与肺损伤程度及PF程度密切相关。     

下腔静脉扩张指数在脓毒症休克性急性肾损伤中的作用

目的 探讨下腔静脉扩张指数在脓毒症休克性急性肾损伤(AKI)中的作用.方法 回顾性研究2013年10月至2015年2月新疆医科大学第一附属医院EICU收治的确诊为脓毒症休克且已于液体复苏开始即刻及其后24 h时应用床旁超声测量了下腔静脉吸气及呼气时管径的成年患者62例,按照自液体复苏后24 h时下腔静脉扩张指数(dIVC),dIVC≥9％组为H组,dIVC＜ 9％组为L组,收集液体复苏即刻及其后24 h时的血肌酐(Scr)值、血流动力学监测指标、APACHEⅡ评分、血清乳酸(Lac)水平并统计AKI发生率、EICU内病死率及其确诊后28 d病死率,观察dIVC对EICU内脓毒症休克性急性肾损伤的发生率及对其预后所产生的影响.结果 所有患者中共有41例发生AKI,其中L组和H组分别为26例、15例,L组AKI发生率高于H组,其差异具有统计学意义(x2=5.047,P＜0.05);所有患者中有23例在EICU内发生死亡,其中L组为16例(48.5％),H组为7例(24.1％),L组明显高于H组(x2 =3.921,P＜0.05);两组患者确诊28d后共死亡29例,L组和H组分别死亡18例(54.5％)、11例(37.9％),L组患者病死率虽高于H组,但差异无统计学意义(x2=1.711,P＞0.05).确诊28 d后死亡的患者中,发生AKI患者23例,而未发生AKI患者有6例,两组间差异有统计学意义(x2=4.226,P＜0.05).结论 脓毒症休克性AKI可加重脓毒症休克患者的不良预后,而过低的dIVC可增加脓毒症休克性AKI的发生风险,进而加重其不良预后.所以,在脓毒症休克患者的液体复苏过程中应注意避免追求过低的dIVC,以免加重其不良预后.     

Comparison of systemic and regional effects of dobutamine and dopexamine in norepinephrine-treated septic shock

Objectives: To compare the effects of dobutamine and dopexamine on systemic hemodynamics, lactate metabolism, renal function and the intramucosal-arterial PCO₂ gap in norepinephrine-treated septic shock. Design: A prospective, interventional, randomized clinical trial. Setting: Adult medical/surgical intensive care unit in a university hospital. Patients: After volume resuscitation, 24 patients were treated with norepinephrine alone titrated to obtain a mean arterial pressure of 75 mmHg and a cardiac index greater than 3.5 l/min^-1· m^-2. Interventions: Patients were randomized to receive an infusion of dobutamine (n = 12) (5 μg/kg per min) or dopexamine (n = 12) (1 μg/kg per min). Measurements and main results: Baseline measurements included: hemodynamic parameters, renal parameters (diuresis, creatinine clearance and urinary sodium excretion), gastric mucosal-arterial PCO₂ gap, arterial and mixed venous gases and arterial lactate and pyruvate levels. These measurements were repeated after 1 (H₁), 4 (H₄) and 24 (H₂₄) h. No difference was found between dobutamine and dopexamine among H₀ and H₁, H₄ and H₂₄ values for hemodynamics. Dobutamine and dopexamine at low doses had no significant effect on mean arterial pressure, heart rate, cardiac index, oxygen delivery, oxygen consumption and pulmonary artery occlusion pressure. No patients developed arrhythmia or electrocardiographic signs of myocardial ischemia. After 4 and 24 h lactate concentration decreased in the dobutamine group from 2.4 ± 1 mmol/l to 1.7 ± 0.7 mmol/l and 1.5 ± 0.4 mmol/l, respectively, while it increased in the dopexamine group from 2.3 ± 1 mmol/l to 2.7 ± 1 mmol/l after 4 h and returned to baseline values after 24 h (2.2 ± 0.6). After 24 h the lactate/pyruvate ratio decreased in the dobutamine group from 15 ± 5 to 12 ± 3 (p < 0.05) while it was unchanged in the dopexamine group (from 16 ± 6 to 17 ± 4). Arterial pH increased in the dobutamine group from 7.35 ± 0.05 to 7.38 ± 0.07 (p < 0.05) while it was unchanged in the dopexamine group (from 7.34 ± 0.01 to 7.35 ± 0.10). The PCO₂ gap decreased after 1 and 4 h in both the dobutamine and dopexamine groups (p < 0.05 with respect to baseline). When looking at individual responses, however, patients from both groups exhibited an increased gastric PCO₂ gap. No difference was found between dobutamine and dopexamine for renal parameters. Conclusions: In norepinephrine-treated septic shock, low doses of neither dobutamine nor dopexamine caused significant effects on systemic hemodynamics and renal function and both dobutamine and dopexamine inconsistently improved the PCO₂ gap. The present results support the need for individual measurement of the effects of catecholamine on the PCO₂ gap. Received: 26 October 1998 Final revision received: 11 April 1999 Accepted: 8 June 1999     

高容量血液滤过对感染性休克所致急性肾损伤影响的实验研究

目的研究高容量血液滤过(High Volume Hemofiltration,HVHF)对感染性休克所致急性肾损伤(Acute Kidney Injury,AKI)的影响,并探讨其可能机制。方法 18只猪随机分为对照组、连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)组和HVHF组,静脉注射大肠杆菌脂多糖(lipopolysaccharide,LPS)诱导感染性休克模型。各组给予液体复苏及血管活性药物维持保证组织灌注,复苏成功后根据分组给予不同处理:对照组不予特殊处理,CRRT组和HVHF组分别行超滤率为25ml/(kg·h)和85ml/(kg·h)的血液滤过治疗。记录各组血流动力学指标、血管活性药物用量及维持时间,检测血浆中IL-6和IL-10浓度、肾组织NF-k B表达水平,并观察肾组织病理改变。结果各组在给入LPS后约40~60min成功复制出休克模型;各组血流动力学指标在30min、40min、50min及60min时间点与基础相比差异均有统计学意义(P0.05);HVHF组CO值在T6时下降较少,高于基础正常值,与其它两组相比具有统计学差异(P0.05);HVHF组的d Pmax在T4、T5、T6时较其它两组有明显升高(P0.05);HVHF组的补液量较其它两组明显减少(P0.01),CRRT组较对照组减少(P0.05);在T4、T5、T6时间点HVHF组去甲肾上腺素用量较前下降,与其它两组相比有明显统计学差异(P0.01);与CRRT组相比,HVHF组IL-6在T3-T6下降明显,IL-10在T2-T6下降明显,差异均有统计学意义(P0.05);HVHF组肾NF-k B的m RNA相对表达量明显低于其它两组(P0.01),CRRT组低于对照组(P0.05);与对照组及CRRT组相比,HVHF组肾脏病理评分明显降低(P0.01)。结论 HVHF能够减少血管活性药物的用量和液体复苏量,有效降低血浆IL-6、IL-10浓度及肾组织NF-k B的表达水平,改善肾组织病理改变,对感染性AKI具有一定的肾保护作用。     

"失血性休克-内毒素"二次打击所致肺损伤水通道蛋白的表达

目的 探讨水通道蛋白（AQP）-1和AQP-5在失血性休克一内毒素二次打击所致大鼠肺损伤中的表达。方法 30只SD大鼠随机分为两组：假手术对照组（C组）、二次打击组（HS组），每组15只。建立“未控制性失血性休克-内毒素”二次打击大鼠模型，并按院前期90min、院内复苏期60min、院内观察期三期进行实验。实验结束前采血测动脉血气并比较两组大鼠存活率。测定肺泡灌洗液蛋白（BALFpro）、肺通透指数（PPI）及肺组织湿／干质量比（W／D）；HE染色光镜下观察肺损伤程度；采用免疫组化法分别测定肺组织AQP-1和AQP-5的蛋白表达。结果 与C组比较，Hs组MAP、lac、PaO2、pH、BE、PPI、BALFpro、W／D等指标均明显恶化，肺组织损伤严重，大鼠存活率降低；与C组比较，HS组肺组织AQP-1和AQP-5的表达显著降低（P〈0．01）。结论 二次打击所致大鼠肺损伤时AQP-1和AQP-5表达均明显降低，这可能是失血性休克后肺损伤肺水肿形成的重要原因之一。