低剂量不同浓度盐水对于失血休克家兔血流动力学的影响

目的：研究不同浓度盐水（4.5％与7.5％）对非控制性失血性休克家兔早期复苏效果的影响，尤其是对家兔血流动力学的影响。方法将32只家兔随机分成4组，每组8只，分别为假手术组（SHAM组）、休克未治疗组（SWT组）、4.5％盐水复苏组（4.5％组）、7.5％盐水复苏组（7.5％组），麻醉后建立非控制性失血性休克模型，在设定时间内，使用预定方案进行液体复苏，监测不同时间点（0min、30min、60min、90min）家兔血流动力学指标（左心室内压（left intraventricular systolic pressure，LVSP）、左心室压力上升或下降的最大速率（the maximal change rate of left intraventricular pressure，±dp/dtmax）的变化情况。结果（1）30min时，SWT、4.5％组、7.5％组各组数值与SHAM组比较，均发生明显改变（P＜0.05），这三组两两比较无统计学差异（P＞0.05），表明休克模型复制成功；（2）三种血流动力学指标实验过程中变化趋势比较一致，60min、90min时，SWT组与其他三组相比较，LVSP、±dp/dtmax值明显减小（P＜0.05）；60min时，7.5％组的LVSP、±dp/dtmax值明显大于4.5％组，差异有统计学意义（P＜0.05）；90min时，7.5％组数值略大于4.5％组，但是差异无统计学意义（P＞0.05）。结论采用液体复苏可以改善家兔的血流动力学指标；与4.5％高渗盐水相比，7.5％高渗盐水在改善非控制性失血性休克家兔血流动力学方面作用更为明显，为临床失血性休克伤员的救治提供了一定的数据支持。

Effects of different hypertonic saline in fluid resuscitation on hemodynamic in hemorrhagic shock in traumatic rabbit

Objective To study the effects of different hypertonic saline (4.5% and 7.5%) in fluid resuscitation on hemodynamics in traumatic rabbits with hemorrhagic shock. Methods Thirty-two healthy rabbits (male or female, 2.0-3.0 kg body weight) were divided into 4 groups randomly: SHAM group, SWT group (shock without treatment), 4.5% group (resuscitation with 4.5% hypertonic saline), and 7.5% group (resuscitation with 7.5% hypertonic saline), 8 rabbits in each group. The rabbit model of uncontrolled hemorrhagic shock was established after anesthesia. The fluid used in the two methods of fluid resuscitation was infused into the rabbits at designed times. The hemodynamic data including the left intraventricular systolic pressure (LVSP) and maximal change rate of left intraventricular pressure (±dp/dtmax) were determined at 0 min, 30 min, 60 min, and 90 min. Results (1) The rabbit models of uncontrolled hemorrhagic shock were generated successfully. At 30 min, data of SWT in the 4.5% and 7.5% groups had no significant difference through pairwise comparison (P>0.05). (2) The hemodynamic parameters changed similarly during the experiment. At 60 min, the values of the 7.5% group (LVSP=115.00±8.37 mmHg, +dp/dtmax=4.29±0.50 mmHg/ms, -dp/dtmax=-3.25±0.25 mmHg/ms) were significantly higher than those in the 4.5% group ((LVSP=104.14±7.73 mmHg, +dp/dtmax=3.35±0.39 mmHg/ms, -dp/dtmax=-2.27±0.12 mmHg/ms) (P<0.05). At 90 min, the data of the 7.5% group were higher, but statistically not significantly different (P>0.05). Conclusions Fluid resuscitation can improve the hemodynamic function in traumatic rabbits with uncontrolled hemorrhagic shock. Comparing with the 4.5% hypertonic saline, 7.5% hypertonic saline can improve the hemodynamic function more apparently. Our results may provide an experimental support for the treatment of clinical patients with uncontrolled hemorrhagic shock.