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目的　探讨限制性液体复苏对出血未控制性休克后续救治的影响。方法　应用脾组织和血管损伤制作重度未控制出血性休克模型 ,比较早期限制液体复苏 [平均动脉压 (MAP)分别维持在 4 0mmHg(NS4 0组 ,1mmHg =0 .133kPa)、5 0mmHg(NS5 0组 )和 6 0mmHg(NS6 0组 ) ]和大量液体复苏 [MAP分别维持在 80mmHg(NS80组 )和 10 0mmHg(NS10 0组 ) ]对MAP、血乳酸 (BL)、红细胞压积 (HCT)、出血量、输液量及存活率的影响。结果　NS4 0、NS5 0和NS6 0组的出血量、液体用量和存活率明显低于NS80和NS10 0组 (P均 <0 .0 5 ) ;伤后4 5min ,NS80和NS10 0组HCT明显低于NS4 0、NS5 0和NS6 0组 (P均 <0 .0 5 ) ;伤后 4 0 5min ,NS80和NS10 0组的HCT明显低于NS5 0和NS6 0组 ,MAP明显低于NS4 0、NS5 0和NS6 0组 ,血乳酸明显高于NS4 0、NS5 0和NS6 0组 (P均 <0 .0 5 )。结论　在出血未控制条件下 ,早期限制性液体复苏可明显降低出血量 ,减轻酸中毒 ,为后续救治创造条件 ,并有利于最终存活率的提高

Effects of limited resuscitaion on following treatment in a model of uncontrolled hemorrhagic shock

Objective To investigate the effect of limited resuscitation(LR) on following treatment in a model of uncontrolled hemorrhagic shock.Methods Uncontrolled hemorrhagic shock was produced in 60 rats by a standardized massive splenic injury with a transected middle branch of splenic artery(MSIA).Mean arterial pressure(MAP),blood lactate(BL),hematocrit(HCT)and blood loss,infusion volume,survival rate were compared between early phase limited resuscitation[MAP maintaining 40mmHg (NS40 group),50mmHg(NS 50 group)and 60mmHg (NS 60 group)] and infusion with large volume resuscitation[MAP maintatining 80 mmHg(NS 80 group and 100mmHg (NS100 group)].Results Blood loss,infusion volume and survival rate were significantly higer in NS40 group,NS50 group and NS60 group compared with NS80 group and NS100 group(P<0.05);HCT in NS40 group,NS50 group and NS60 group were significantly higher than in NS80 group and NS100 group at 45min (P<0.05);HCT in NS80 gropu and NS100 group were significantly lower than in NS50 gropu and NS60 group at 405min,at the same time,MAP in NS80 and NS100 group significantly lower than NS40,NS50 and NS60 group,BL in NS80 and NS100 group significantly higher than in NS40,NS50 and NS60 gropu(P<0.05).Conclusion In the setting of uncontrolled hemorrhagic shock,LR obviously reduces blood loss,relieves acidemia and improves long-term survival for the following treatment.