复苏液温度对急性失血性休克兔肠系膜微循环的影响

目的观察兔失血性休克输注不同温度的复苏液时肠系膜微循环的变化特点,为临床复苏应用适宜的复苏液温度提供依据。方法选择健康新西兰雄兔32只,随机分为四组：假手术组、低温组、常温组、温热组,后三组复制休克模型,模型稳定30min后将后三组按相同速度分别给予低温、常温、及温热平衡液和自体血复苏,于休克前、休克时、开始复苏后1、2、3h分别测定兔肠系膜微血管管径、红细胞流速、微血管数目的变化及平均动脉压的变化。实验结束后取邻近部位小肠做病理检查。结果液体复苏后低温组、常温组、温热组兔肠系膜微血管管径、红细胞流速、微血管数目及平均动脉压均高于休克时（P〈0.05）。复苏过程中温热组兔肠系膜微血管管径、红细胞流速及平均动脉压高于常温组和低温组（P〈0.05）。邻近部位小肠病理学检查结果低温复苏组兔小肠出血坏死、黏膜脱落较常见,而常温复苏组及温热液体复苏组的病变较轻,表现为组织水肿较常见。结论失血性休克可引起兔肠系膜微循环障碍,微血管管径、红细胞流速、微血管数目均下降,温热液体复苏更有助于改善肠系膜微循环。

Effect of Temperature of Fluid Infusion on Mesenteric Microcirculation in Acute Hemorrhagic Shock Rabbits

Objective To investigate the effect of different temperattrre of fluid infusion on mesenteric microcirculation in acute hemorrhagic shock rabbits so as to provide a clue to improve the treatment to the patients with hemorrhagic shock. Methods An animal model of controlled hemorrhagic shock of rabbits was used. 32 New Zealand male rabbits were randomly divided into four groups： sham operated group, a warm fluid infusion group, a room temperature fluid infusion group and a cold fluid infusion group. The rabbits were then resusci- tated with Ringer~ lactate solution. The mesenteric microcirculation in rabbits was observed. The capillary ves- sel diameter, the blood flow velocity of red blood cells, the number of vessels and the mean arterial pressure were measured before shock, during shock, and lh, 2h, 3h after resuscitating, respectively. Results The diameter of blood vessels, red blood cells flow, micro-vascular circulation numbers and mean arterial pressure were higher than those in shock after resuscitating in all the resuscitating groups（P 〈 0.05）. Recovery in the course, mesenteric small-circle diameter, RBC velocity and mean arterial pressure of fluid infusion group are higher than those of room temperature group and hypothermia group（ P 〈 0.05）. In neighbouring parts of small intestine pathology results of low temperature recovery rabbit, intestinal bleeding necrosis and mucosal shedding are more common. In recovery group at room temperature and hot liquid recovery group, edema is more common. Conclusion Hemorrhagic shock can cause rabbit mesenteric microcirculation barrier. The microvascular diameter, the flow rate of red blood cells, micro-vascular circulation number are declining. The warm liquid recovery is helpful in improving the small mesentery microcirculation.