3种晶体液复苏对失血性休克大鼠的影响

目的 探讨不同晶体液复苏对失血性休克大鼠的影响.方法 雄性SD大鼠40只,随机分为对照组、休克组、生理盐水组、乳酸林格液组和醋酸林格液组,每组8只.生理盐水组、乳酸林格液组和醋酸林格液组放血至平均动脉压(MAP)30~40 mmHg后维持60 min,分别给予3倍失血量的晶体液进行复苏60 min.记录5组大鼠生理指标直至复苏结束.分别于基础阶段(0 min)、失血阶段(10 min)、休克阶段(70 min)和复苏阶段(130 min)行血气和生化检测,记录各组生存情况.结果 休克组和3个液体复苏组失血和休克阶段MAP、pH、红细胞比容(Hct)、碱剩余(BE)低于对照组,休克指数(SI)和乳酸(Lac)高于对照组(P<0.05).复苏阶段3个液体复苏组MAP低于对照组,高于休克组,SI高于对照组,低于休克组(P<0.05);休克组pH和BE均低于对照组,3个液体复苏组均高于休克组(P<0.05);休克组和3个液体复苏组Hct低于对照组,且3个液体复苏组低于休克组(P<0.05);休克组和乳酸林格液组Lac高于对照组、生理盐水组和醋酸林格液组(P<0.05).失血阶段休克组和3个液体复苏组丙氨酸转氨酶(ALT)均较对照组升高(P<0.05).休克阶段和复苏阶段休克组和3个液体复苏组生化指标均较对照组升高(P<0.05);复苏阶段3个液体复苏组生化指标低于休克组,乳酸林格液组乳酸脱氢酶(LDH)高于醋酸林格液组,生理盐水组肌酸激酶(CK)高于醋酸林格液组,乳酸林格液组ALT高于生理盐水组和醋酸林格液组(P<0.05).3个液体复苏组生存时间均长于休克组(P<0.05),醋酸林格液组生存时间长于生理盐水组和乳酸林格液组,但差异无统计学意义(P>0.05).结论 对于失血性休克进行晶体液复苏时,醋酸林格液相对于生理盐水和乳酸林格液在改善代谢情况、减缓脏器损伤和延长生存时间等方面具有一定优势.

Effects of Resuscitation with Three Crystalloid Solutions on Rats with Hemorrhagic Shock

Objective To investigate effects of resuscitation with different crystalloid solutions on rats with hem-orrhagic shock. Methods A total of 40 male SD rats were randomly divided into control group ( n=8 ) , shock group (n=8), physiological saline group (n=8), Ringer lactate solution group (n=8) and acetated Ringer solution group (n=8). The physiological saline, Ringer lactate solution and acetated Ringer solution groups were exsanguinated until mean arterial pressure ( MAP) dropped to 30-40 mmHg, and were maintained for 60 min, and then were resuscitated with crystalloid solutions which were threefold of the loss blood volume for 60 min respectively. Physiological indexes were re-corded until the end of resuscitation. such as MAP,systolic blood pressure( SBP) and heart rate( HR) . Blood gas and bi-ochemical indexes were recorded at the baseline ( 0 min ) , blood loss ( 10 min ) , shock ( 70 min ) and resuscitation (130 min) stages, and survival conditions were also recorded in all groups. Results Compared with those in the control group, the values of MAP, hydrogen ion concentration ( pH) , hematocrit ( Hct) and base excess ( BE) were lower, while values of shock index ( SI) and lactic acid ( Lac) were higher in the shock group and the three fluid resuscitation groups at the blood loss and shock stages (P<0. 05). At the resuscitation stage, in the three fluid resuscitation groups, MAP values were lower, while SI values were higher than those in the control group, and MAP values were higher, while SI values were lower than those in the shock group(P<0. 05);pH and BE values in the shock group were lower than those in the control group, while the values in the three fluid resuscitation groups were higher than those in the shock group (P<0. 05);Hct values in the shock and the three fluid resuscitation groups were lower than that in the control group, and the values in three fluid resuscitation groups were lower than that in the shock group (P<0. 05);Lac values in the shock and the Ringer lactate solution groups were higher than those in the control, physiological saline and acetated Rin-ger solution groups (P<0. 05). At the blood loss stage, alanine aminotransferase (ALT) values in the shock and the three fluid resuscitation groups were higher than that in the control group (P<0. 05). At the shock and resuscitation sta-ges, biochemical indexes in the shock and the three fluid resuscitation groups were higher than those in the control group (P<0. 05);at the resuscitation stage, biochemical indexes in the three fluid resuscitation groups were lower than those in the shock group, lactate dehydrogenase ( LDH) value in the Ringer lactate solution group was higher than that of the acetated Ringer solution group, and creatine kinase ( CK) value in the physiological saline group was higher than that in the acetated Ringer solution group, and ALT value in the acetated Ringer solution group was higher than those in the physiological saline and acetated Ringer solution groups (P<0. 05). Survival times in the three fluid resuscitation groups were longer than that in the shock group ( P<0. 05 ) , and the time in acetated Ringer solution group was longer than those in physiological saline and Ringer lactate solution groups, but the differences were not statistically significant ( P>0. 05). Conclusion During fluid resuscitation with crystalloid solution for hemorrhagic shock, acetated Ringer solution may achieve better effects in improving metabolisms, mitigating organ injuries and prolonging survival time compared with those by physiological saline and Ringer lactate solution.