国际麻醉学与复苏杂志   2011, Issue (5): 541-545
    
低温暴露对失血性休克血流动力学和氧动力学的影响
余莉 张成 张雪峰 张铁铮1()
1.第四军医大学
Effects of environmental hypothermia on hemodynamics and oxygen dynamics in hemorrhagic shock pigs
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摘要:

【摘要】 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只,随机分为2组(n=8):常温对照组(C组)和低温暴露组(H组)。两组猪均在15min内按30mL•kg-1量匀速放血,造成容量控制性失血性休克,监测放血前(T0)和放血后4h内不同时点(T1~T10)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)和心输出量(CO),并计算每搏量(SV)和体循环阻力(SVR);通过血气分析监测乳酸(LA)、混合静脉血氧饱和度(SmvO2),并计算氧摄取量(Ca-vO2)、氧供(DO2)、氧耗(VO2)、氧摄取率(O2ER)和动静脉CO2分压差(ΔPCO2);记录每头猪的生存时间。 结果 与C组相比,H组在T1时,HR较慢(P﹤0.05);T3~T9时,MAP较高(P﹤0.05);T10时,CO较少(P﹤0.05);T7~T10时,SV较低(P﹤0.05);T3~T10时,SVR较高(P﹤0.05);T7~T10时,SmvO2较低(P﹤0.05),Ca-vO2 和ERO2较高(P﹤0.05),其他指标无显著性差异(P﹥0.05)。Kaplan-Meier生存分析显示C组生存状况 优于H组(Log-rank检验P=0.025)。 结论 低温暴露下,HS机体较常温组体循环阻力增高,心排量较低,氧代谢紊乱更加复杂,对HS机体是一个创伤加剧因素,使其病程更快进展至失代偿期,增加短期死亡率。

关键词: 【关键词】 低温暴露;失血性休克;血流动力学;氧动力学
Abstract:

[Abstract] Objective To study effects of environmental hypothermia on hemodynamics and oxygen dynamics in hemorrhagic shock (HS) pigs. Methods sixteen healthy Bama miniature pigs were randomly divided into 2 groups (n = 8): normal temperature group (group C) and environmental hypothermia exposure group (group H). Blood of all pigs were withdrawn by 30 ml•kg-1 in 15min at equal pace to achieved capacity controlled hemorrhagic shock. Record all models’ heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary artery pressure (MPAP), pulmonary artery wedge pressure (PAWP) and cardiac output (CO) consecutively, and calculated stroke volume (SV) and systemic vascular resistance (SVR); and blood gas analysis through the artery, pulmonary artery blood for monitoring blood lactate (LA), mixed venous oxygen saturation (SmvO2), and calculating the oxygen uptake (Ca-vO2) , oxygen delivery (DO2),oxygen consumption(VO2), oxygen extraction ratio(O2ER)and ΔPCO2 at time of pro-bleed (T0) and different time points in 4h (T1~T10) of post-bleed, record survive time of all pigs. Results Compared with group C, at time of T1, HR was slower ( P <0.05), in the time of T3~T9, MAP was higher ( P <0.05), at time of T10, CO was lower ( P <0.05), in the time of T7~T10, SV was lower ( P <0.05), in the time of T3~T10, SVR was higher ( P <0.05) in group H. When in the time of T7~T10, compare with group C, SmvO2 was lower (P <0.05), Ca-vO2 and O2ER was higher ( P <0.05) in group H, other indexes have no significant comparison statistically (P> 0.05). Kaplan-Meier survival analysis showed that the living conditions in group C was better than group H (Log-rank test P = 0.025). Conclusion Compared with normal temperature group, vascular resistance was higher, cardiac output was lower and oxygen metabolism was more complex when HS body was exposed in environmental hypothermia. Environmental hypothermia can overwhelm HS body, the natural progression of the HS body was accelerated and its short-term mortality was increased.

Key words: [Key words] Environmental hypothermia exposure; Hemorrhagic shock; Hemodynamics; Oxygen dynamics