多沙普仑对犬失血性休克等容输血后血流动力学的影响

目的：观察多沙普仑对犬失血性休克等容输血后血流动力学的影响。方法：犬分为对照组和多沙普仑组（只数均＝５）。股动脉快速放血３０ｍｌ／ｋｇ，造成严重休克模型，３０分钟后等容输血。多沙普仑组输血后立即静脉注射多沙普仑２ｍｇ／ｋｇ。用Ｓｗａｎ－Ｇａｎｚ漂浮导管等方法分别于休克、输血前后测定血流动力学参数。结果：休克后５分钟、３０分钟ＭＡＰ、ＣＯ、ＣＩ、ＳＶ、ＬＶＳＷ、ＬＶＳＷＩ明显下降，ＳＶＲ明显增高。输血后１５分钟，多沙普仑组已恢复到休克前水平，但对照组则未能恢复。结论：多沙普仑能促进失血性休克等容输血后循环功能的恢复。     

低温暴露对失血性休克血流动力学和氧动力学的影响

目的 研究低温暴露对失血性休克猪血流动力学和氧动力学的影响.方法 巴马小型猪16头,采用随机数字表法分为2组(每组8头):常温对照组(C组)和低温实验组(H组).2组猪均在15 min内按全身血容量的40％(即按30 ml/kg计算)匀速放血制备休克模型后,分别置于20℃～22℃常温和0℃～5℃低温环境中,监测和计算放...     

每搏输出量变异度和胸腔内血容量指数对失血性休克犬容量状态的评价

目的探讨每搏输出量变异度（SVV）和胸腔内血容量指数（ITBI）在失血性休克犬容量状态评价中的意义。方法以改良Wiggers’法复制失血性休克犬模型,Swan-Ganz导管和PiCCO仪监测血流动力学,重复行容量负荷试验,根据每搏输出量的变化（△SV）是否大于5％分为反应组和无反应组。结果14只犬共行容量负荷试验134次,反应组94次,无反应组40次。容量负荷试验后反应组心率（HR）、平均动脉压（MAP）、SVV和ITBI的变化明显大于无反应组。反应组中心静脉压（CVP）和肺动脉楔压（PAWP）的变化明显小于无反应组。ITBI、SVV与ASV显著相关,HR、MAP、CVP、PAWP与ASV无明显相关。容量负荷试验后△CVP、△PAWP、△ITBI、△SVV与△SV显著相关,而△HR、△MAP与△SV无明显相关。受试犬操作特征（ROC）曲线：SVV的曲线下面积（AUC）为0．872,ITBI的AUC为0．689,明显高于HR、MAP、CVP和PAWP（0．294～0．593）。SVV大于9．5％对容量负荷试验有反应的敏感性为92．6％,特异性为82．5％。结论SVV和ITBI对容量状态的评价明显优于CVP和PAWP。SVV持续监测有助于容量状态评价和液体管理。     

严重烧伤休克期大面积切痂对休克复苏的影响

目的 评价休克期大面积切痂对休克复苏的影响。方法 采用40％TBSAⅢ度烫伤犬模型,随机分为切痂组(E组)和非切痂组(C组)。两组动物于伤后1h按parkland公式补充复方乳酸钠溶液复苏,E组在伤后3h切除全部焦痂,立即植以新鲜异体皮。动态观察血流动力学、血液流变学、氧供、氧耗和血乳酸的变化。结果两组犬烫伤后30min均立即发生严重休克,心排出量(CO)、心脏指数(CI)、左心作功指数(LVWI)显著降低,全血粘度、血浆粘度、红细胞聚集指数、血浆乳酸含量明显增加。E组动物伤后3h切痂,CO、CI、血液流变学和乳酸含量较术前及C组均有明显改善。结论 烧伤后单纯补液不能较快纠正休克,休克期大面积切痂是安全可行的,并能有效纠正休克。     

The effect of aprotinin in a model of uncontrolled hemorrhagic shock

BACKGROUND: Aprotinin has been shown to promote clot formation through its antifibrinolytic activity, by inhibiting the plasmin-induced complement activation and by protecting the platelets adhesive surface receptors. It has been successfully used in cardiac and liver transplantation surgery. OBJECTIVE: To evaluate the effect of aprotinin in a model of uncontrolled intra-abdominal bleeding as a basis for its potential use in trauma patients. METHODS: Twenty rats were randomly divided into 2 groups. All animals were operated on and bleeding was induced by transecting 1 lobe of the liver. In the treatment group a single dose of 30,000 U/kg of aprotinin was administered 5 minutes after the injury. The animals were monitored for hemodynamic parameters, blood loss volume, and mortality rates. RESULTS: At 120 minutes from trauma induction a significant difference in mean blood pressure was observed: 67+/-22 mm Hg in the treatment group versus 53+/-28 mm Hg in the control group (P=.04). This difference remained consistent until the end of the experiment. Treatment with aprotinin also resulted in a tendency to an increased survival rate (P=.05) and increased mean survival time: 175+/-46 minutes as compared to 123+/-48 minutes in the controls (P=.027). CONCLUSIONS: Early administration of aprotinin resulted in temporary hemodynamic stabilization and prolonged survival in a model of uncontrolled bleeding. Further studies are needed to establish the possible use of aprotinin in the treatment of trauma patients.     

胸腔内血容量指数对失血性休克犬容量状态评价的意义

目的：探讨胸腔内血容量指数（ITBVI）在失血性休克犬容量状态评价中的意义。方法：以改良的Wiggers法复制失血性休克犬模型，重复进行容量负荷试验（林格液7ml／kg在2min内滴入）。肺动脉漂浮导管监测中心静脉压（CVP）、心输出量（CO）、肺动脉楔压（PAWP）等，PiCCO（脉搏指示连续心输出量监测）仪监测CO、平均动脉压（MAP）、胸腔内血容量指数（ITBVI），记录容量负荷试验前及试验后5min的上述指标。当每搏输出量变化（△SV）不再增加时（即ASV小于0时）终止实验。结果：两种方法测量CO比较无统计学差异（P〉0．05）。造模后与造模前相比HR的升高，MAP、ITBVI、SV的下降有显著性差异。CVP、PAWP的改变无显著性差异，复苏终点与造模前相比各指标均无显著性差异，复苏终点与造模后相比各指标均有显著性差异。ITBVI、HR、MAP与ASV有显著相关性，相关系数γ分别为0．546、-0．312和0．340，而CVP、PAWP与ASV无相关，容量复苏试验后胸腔内血容量指数变化（△ITBVI）与SV、ASV之间有显著相关性，相关系数γ为0．563，而ACVP、APAWP、AHR、AMAP与ASV无相关性。结论：ITBVI及其容量复苏后的变化与ASV明显相关，可能有助于容量状态评价和液体管理。     

高渗氯化钠羟乙基淀粉40注射液对失血性休克大鼠凝血功能的影响

目的 观察高渗氯化钠羟乙基淀粉40注射液(高渗晶胶液)对失血性休克大鼠复苏过程中凝血功能的影响.方法 16只SD大鼠随机均分为高渗晶胶液复苏组(H组)和复方乳酸钠复苏组(L组),将16只SD大鼠制成失血性休克模型后,分别使用高渗晶胶液和复方乳酸钠各6 ml/kg进行复苏,在休克前(T1)、休克后60 min(复苏前,T2)及复苏后5 min(T3)、30 min(T4)、60 min(T5)时记录血压,取血浆分别测定出血时间(BT)、凝血时间(TT)、凝血酶原时间(PT)、白陶土部分凝血活酶时间(KPTT)和纤维蛋白原(Fib).结果 两组在T2～T5时BT、TT、PT、KPTT均明显长于T1时(P<0.05),Fib明显低于T1时(P<0.05);H组在T3～T5时BT、TT、PT、KPTT均明显短于L组(P<0.05);两组之间Fib在各时点差异无统计学意义.结论 高渗晶胶液对失血性休克凝血功能有影响,使BT、TT、PT、KPTT延长,Fib降低,但尚未超过机体的代偿范围.应用高渗晶胶液进行液体复苏时应在临床推荐剂量内,同时加强凝血功能的监测和控制.     

The effect of various resuscitative regimens on hemorrhagic shock in puppies

Since shock secondary to hemorrhage is not infrequently encountered in the pediatric patient, a puppy model was devised to help measure and monitor cardiovascular and metabolic changes that occur before and after resuscitation from hypovolemic shock (mean arterial pressure of 50 mm Hg for 1 hr). Three resuscitation protocols were compared: whole blood (replacement: shed) 1:1, 5% albumin in Ringer's lactate 1:1, and Ringer's lactate 3:1. All dogs survived the experiment and responded similarly during the shock period. Thermal dilution cardiac output rose in all groups after resuscitation; however, in the Ringer's lactate and 5% albumin groups, cardiac output was statistically greater than that observed in the blood group. In all groups, pH and blood pressure approached but did not return completely to baseline levels after resuscitation. In addition, early resuscitation demonstrated a further decrease in pH (“hidden acidosis”) before it began to return toward normal as resuscitation progressed. This study suggests that the infusion of large volumes of Ringer's lactate or 5% albumin in Ringer's lactate are equally efficacious in the treatment of hemorrhage. However, 5% albumin seems to be preferable because it allows infusion of a smaller quantity of electrolyte solution with equivalent physiologic benefits.     

外源性磷酸肌酸抗失血性休克兔心肌损伤作用的研究

目的研究磷酸肌酸对失血性休克家兔心肌缺血再灌注损伤的保护作用。方法新西兰大耳白兔20只,随机分为磷酸肌酸注射液治疗组（CP组）和生理盐水对照组（N组）,各10只。制作家兔失血性休克模型,监测血流动力学指标（MAP）;分别于休克前（T0）、休克60min（T1）、复苏30min（T2）、60min（T3）、120min（T4）5个时间点抽血检测心肌肌钙蛋白（IcTnI）和肌酸激酶（CK）,实验终点取心脏组织观察其病理学及超微结构的改变,检测心肌线粒体Na＋-K＋-ATP酶和Ca2＋-ATP酶活性,并用TUNEL法检测心肌细胞的凋亡。结果与N组比较,CP组心肌病理组织学改变程度较轻;CP组在复苏期各个时间点的CK值和cTnI值均明显减低（P〈0.05）;CP组家兔心肌线粒体中的Na＋-K＋-ATP酶和Ca2＋-ATP酶活力均明显升高;CP组心肌TUNEL阳性细胞明显减少（P〈0.05）。结论磷酸肌酸具有抗失血性休克所致的心肌再灌注损伤作用。     

End-tidal CO2 on admission is associated with hemorrhagic shock and predicts the need for massive transfusion as defined by the critical administration threshold: A pilot study

BackgroundCritical administration threshold (≥3 units of packed red blood cells/h or CAT+) has been proposed as a new definition for massive transfusion (MT) that includes volume and rate of blood transfusion. CAT+ has been shown to eliminate survivor bias and be a better predictor of mortality than the traditional MT (>10 units/24 h). End-tidal CO₂ (ET CO₂) negatively correlates with lactate and is an early predictor of shock in trauma patients. We conducted a pilot study to test the hypothesis that low ET CO₂ on admission predicts CAT+.MethodsET CO₂ via capnography and serum lactate were prospectively collected on admission for 131 patients requiring trauma team activation. Demographic data were obtained from patient charts. Excluded were patients with isolated head injuries, traumatic arrests, or pre-hospital intubations. CAT± status was determined for each hour up to 6 h from admission as described; likewise, MT± status was determined up to 24 h from admission.ResultsAfter exclusion criteria, 67 patients were analyzed. Mean age was 41.2 (SD 18.5). Thirty-three patients had a blunt mechanism of injury (49%), median ISS was 9 (interquartile range 4–19), and there were 6 deaths (9%). ET CO₂ and lactate were negatively correlated by Spearman rank-based correlation (rho = −0.41, p = 0.0006). Twenty-one (31%) and 8 (12%) patients were CAT+ and traditional MT+, respectively. There were a significantly greater proportion of patients with ISS > 15, ET CO₂ <35, or who died found to be CAT+. A binomial logistic regression model adjusting for age, SBP <90, HR, and ISS >15 revealed ET CO₂ < 35 to be independently predictive of CAT+ (OR 9.24, 95% CI 1.51-56.57, p = 0.016).ConclusionsThis pilot study demonstrated that low ET CO₂ had strong association with standard indicators for shock and was predictive of patients meeting CAT+ criteria in the first 6 h after admission. Further study to verify these results and to elucidate CAT criteria’s association with mortality will require a larger sample size.     

醋酸钠林格氏液对犬失血性休克复苏过程中血流动力学及血乳酸的影响

目的 比较醋酸钠林格氏液(AR)、乳酸林格氏液(LR)和生理盐水(NS)对失血性休克犬碱剩余(BE)、乳酸(LAC)水平及其血液动力学的影响.方法 将健康成年雄性犬15条随机分为3组:AR组、LR组和NS组,用放血法复制失血性休克模型.分别于放血前、复苏前和复苏后5、30、60 min检测血流动力学参数、动脉血气和血乳酸值.结果 平均动脉压(MAP)恢复至休克前的水平,AR组[(41.10±2.18) ml/kg、(28.15±0.29) min]较LR组[(54.17±2.97) ml/kg、(43.26±0.87) min]、NS组[(59.61±2.88) ml/kg、(48.19±1.23) min]所需输液量更少、时间更短,差异有统计学意义(P＜0.05);复苏30 min后,MAP AR组[(99.25±12.13) mmHg(1mmHg=0.133 kPa)]较LR组[(84.25±11.87)mm Hg]、NS组[(81.25±13.26) mm Hg]明显升高,且AR组较其他组血液pH值、BE及LAC水平显著改善,差异有统计学意义(P＜0.05).结论 醋酸钠林格液比乳酸林格氏液和生理盐水更适合失血性休克犬的早期紧急液体复苏治疗.     

去白细胞血和红细胞-代血浆对犬失血性休克的疗效

目的评价去白细胞血和红细胞-代血浆对犬失血性休克的疗效及其机制。方法成年家犬24只,随机分为4组(n=6):代血浆组(A组)、全血组(B组)、去白细胞血组(C组)和红细胞-代血浆组(D组)。采用Wiggers改良法建立犬可逆性休克模型,放血使平均动脉压降至40 mmHg,并维持60min。各组以10ml·kg-1·min-1速率输注不同液体进行治疗。分别于休克前即刻(T1基础值)、休克60min(T2)和休克治疗后60 min(T3)监测血压(MAP)、心率(HR)、心输出量(CO),同时取静脉血检测血浆丙二醛(MDA)、白细胞介素-1β(IL-1β)、内皮素(ET)、肿瘤坏死因子-α(TNF-α)、血小板活化因子(PAF)以及中性粒细胞表面粘附分子CD11b的水平。结果与T1相比,T2时4组MAP、CO降低,HR增快,血浆MDA、IL-1β、ET、TNF-α、PAF及CD11b的水平均增高;与T2相比,T3时B组、C组、D组HR减慢,4组MAP均升高,血浆MDA、IL-1β、ET、TNF-α、PAF及CD11b水平均降低;与A组相比,B组血浆MDA、IL-1β、CD11b水平降低,C组MAP升高、CO增加,血浆IL-1β、ET及PAF水平降低,D组MAP升高、CO增加、HR减慢,血浆:MDA、IL-1β、ET、PAF及CD11b水平降低;与B组相比,C组和D组CO增加、血浆MDA、IL-1β、ET、PAF及CD11b的水平降低;与C组相比,D组PAF水平降低,其余各指标差异无统计学意义。结论去白细胞血及红细胞-代血浆对犬失血性休克具有良好的治疗效果,其机制与抑制全身炎性反应有关。     

多巴胺及去甲肾上腺素对感染性休克患者血流动力学和组织氧代谢的影响

目的探讨多巴胺(DA)及去甲肾上腺素(NE)在治疗感染性休克过程中对血流动力学和组织氧代谢的影响。方法选择我科腹部外科术后感染性休克患者46例,按随机原则分别给予DA(DA组)或NE(NE组)升压治疗。分别观察入组时、入组后1~6h的血流动力学指标[心率(HR)、平均动脉压(MAP)、心排出量指数(CI)、每搏指数(SI)、体循环阻力指数(SVRI)]、混合静脉血氧饱和度(SvO2)、早期乳酸清除率、28d死亡率;每小时尿量(UV)和12h后肌酐清除率(Ccr)。结果①两组各时间点MAP、CI、SVRI比较差异均无统计学意义,DA组的HR明显高于NE组,而SI低于NE组(P0.05)。②3h后NE组SvO2值较DA组明显增高(P0.05),6h后NE组SvO2≥65%的比例也明显高于DA组;NE组早期乳酸清除率明显高于较DA组[(24.8±15.7)%vs(16.2±14.2)%,P=0.003],NE组高的早期乳酸清除率比例明显高于较DA组,③两组6h后UV以及12h末的Ccr水平无明显差异。④两组之间28d死亡率无统计学差异。结论NE在内脏灌注和组织氧代谢方面优于DA。对于腹部外科术后感染性休克患者,NE可能是更好的选择。     

西沙必利对大鼠出血性休克复苏后胃损害的作用

目的：观察西沙必利对大鼠出血性休克复苏后胃损害的作用。方法：108只Wistar大鼠随机分为假休克(SS)组、出血性休克复苏(HS)组和出血性休克复法律后西少必利治疗（HSC）组，同位素标记生物微球法测量胃血流量，同时测定胃黏膜内pH（pHi）、胃排空、胃黏膜丙二醛（MDA）含量和Na^ -K^ -三磷酸腺苷酶（ATPase）活性，以及门静脉血乳酸水平。结果：HSC组与HS组相比，大鼠胃内色素相对残留率显降低，胃血流量下降幅度减少，2h胃pHi有显回升，4h胃黏膜MDA含量降低、Na^ -K^ -ATPase活性增加，门静脉血乳酸水平显下降。结论：出血性休克复苏后应用西沙必利有改善复苏后持续存在的胃缺血缺氧状态。     

吡那地尔诱导失血性休克大鼠血流动力学保护

目的 观察吡那地尔诱导失血性休克大鼠血流动力学的保护及与线粒体ATP激活钾通道( KATP)的关系.方法 采用失血性休克复苏大鼠,观察吡那地尔预处理对大鼠存活时间、血流动力学指标[平均动脉压(MAP)、左室收缩压(LVSP)、左室舒张末压(LVEDP)、左室压最大上升/下降速率(±dp/dtmax)、心率(HR)]的影响,以及线粒体KATP关闭剂5-羟基癸酸(5-HD)和格列本脲对其效应的作用.结果 吡那地尔预处理显著延长大鼠存活时间,恢复血流动力学,MAP、LVSP、LVEDP、+dp/dtmax、- dp/dtmax、HR分别增高5.9％、11.6％、32.9％、28.0％、28.1％和13.4％(P＜0.01),5-HD和格列本脲可显著抑制其保护效应(P＜0.01).结论 吡那地尔开放线粒体KATP,保护失血性休克大鼠血流动力学,提高存活率.     

组蛋白脱乙酰化酶抑制剂对失血性和感染性休克早期救治作用的研究进展

背景 休克早期的药物救治,一直普遍受到关注,近来组蛋白脱乙酰化酶抑制剂(histone deacetylase inhibitors,HDACI)因其突出的抗休克作用成为国际研究热点. 目的 回顾目前HDACI的临床应用方向和分类,讨论其作为抗失血性休克和感染性休克药物的突出优势以及作用机制. 内容 HDACI可通过抗细胞凋亡等多种途径,提高细胞对休克所致缺血/缺氧环境的耐受能力,改善失血性休克和感染性休克动物模型的预后. 趋向 HDACI已成为抗失血性休克和感染性休克研究的新方向,是提高休克早期生存率的新策略,也为休克的治疗提供了药物配合液体复苏的新途径.     

多沙普仑纳络酮对失血性休克犬等容输血后血流动力学的影响

目的：在实验犬中观察多沙普化、纳络酮对失血性休克等容输血后血流动力学的影响。方法：实验犬分为对照组、多沙普化组和纳络酮组，每组５条，三组动物均以动脉快速放血３０ｍｌ／ｋｇ、造成严重失血性休克模型，３０ｍｉｎ后等容输血，多沙普仑组和纳络酮组分别于输血后立即静脉注射多潲普仑２ｍｇ／ｋｇ或纳络酮０．０１５ｍｇ／ｋｇ，采用Ｓｗａｎ－Ｇａｎｚ漂浮导管及心脏电脑监护仪等手段分别于动物休克、等容输血前后测定血流     

高氧液在抢救重度失血性休克中的临床应用

目的　观察高氧液对重度失血性休克患者血压和微循环的影响。方法　选择重度失血性休克患者 6 0例 ,随机分为治疗组和对照组 ,每组 30例。每组在抢救中除采用止血、输血、输液等相同措施外 ,对照组输入复方乳酸钠 10～ 2 0ml/kg ;治疗组输入等量的高氧液。两组同步观测血压、尿量、血气恢复正常及末梢循环改善所需要的时间。结果　治疗组血压、尿量、血气恢复正常及末梢循环改善所需要的时间均较对照组少 (P <0 0 1)。结论　高氧液对重度失血性休克有稳定血压和改善微循环的作用。     

潘氏细胞在大鼠休克复苏后肠黏膜重建过程中的作用

目的 观察小肠潘氏细胞在大鼠失血性休克复苏后肠黏膜重建过程中的作用。方法 42只雄性Wistar大鼠建立失血性休克复苏模型,随机分为实验组(n=7)和对照组(n=35),实验组再分5组,分别于复苏后1、3、6、12、24h观察回肠黏膜的形态学改变、复苏前后潘氏细胞数量及形态变化特点及各时相电镜下潘氏细胞结构特点。结果 休克复苏后小肠黏膜明显损伤,集中表现于绒毛部分。复苏后3h为明显,6h后绒毛已开始修复,至24h肠黏膜表面细胞连续性已恢复。复苏后1h,回肠黏膜潘氏细胞计数明显减少(P＜0.05),3h降至最低(P＜0.05),6h后与对照组比较,差异无统计学意义(P＞0.05)。电镜下潘氏细胞表现肠内分泌细胞超微结构特征,核无凋亡改变。结论 失血性休克复苏后肠黏膜屏障早期受损,但具快速重建能力,潘氏细胞颗粒的合成和分泌可受缺血再灌注损伤的诱导。潘氏细胞对维持肠道黏膜防御机制具有重要的生理意义。     

Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients

BackgroundVarious scoring systems have been developed to predict need for massive transfusion in traumatically injured patients. Assessments of Blood Consumption (ABC) score and Shock Index (SI) have been shown to be reliable predictors for Massive Transfusion Protocol (MTP) activation. However, no study has directly compared these two scoring systems to determine which is a better predictor for MTP activation. The primary objective was to determine whether ABC or SI better predicted the need for MTP in adult trauma patients with severe hemorrhage.MethodsThis was a retrospective cohort study which included all injured patients who were trauma activations between January 1, 2009 and December 31, 2013 at an urban Level I trauma center. Patients <18 years old or with traumatic brain injury (TBI) were excluded. ABC and SI were calculated for each patient. MTP was defined as need for >10 units PRBC transfusion within 24 h of emergency department arrival. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were used to evaluate scoring systems’ ability to predict effective MTP utilization.ResultsA total of 645 patients had complete data for analysis. Shock Index ≥1 had sensitivity of 67.7% (95% CI 49.5%–82.6%) and specificity of 81.3% (95% CI 78.0%–84.3%) for predicting MTP, and ABC score ≥2 had sensitivity of 47.0% (95% CI 29.8%–64.9%) and specificity of 89.8% (95% CI 87.2%–92.1%). AUROC analyses showed SI to be the strongest predictor followed by ABC score with AUROC values of 0.83 and 0.74, respectively. SI had a significantly greater sensitivity (P = 0.035), but a significantly weaker specificity (P < 0.001) compared to ABC score.ConclusionABC score and Shock Index can both be used to predict need for massive transfusion in trauma patients, however SI is more sensitive and requires less technical skill than ABC score.