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目的比较在失血已控制及失血未控制两种状态下常规液体复苏治疗失血性休克的效果,探索早期液体复苏对策。方法健康雄性SD大鼠28只,随机分为对照组(n=8)、失血已控制休克组(CHS组,n=10)及失血未控制休克组(UHS组,n=10)。CHS组及UHS组大鼠股动脉放血,使血压在15min内降至30mmHg,然后截断3组大鼠尾根部,对照组及CHS组立即结扎止血,UHS组不予处理使其自然流血。模拟战创伤实际情况,将动物分为院前期(30～90min)、医院救治期(90～150min)及康复期(150min～72h)3个阶段。院前期通过输液将大鼠血压维持在60mmHg;医院救治期结扎出血灶,输血、输液维持大鼠血压至90mmHg;康复期观察至72h。监测平均动脉压(MAP)、中心静脉压(CVP)、心功能、血气分析及血细胞比容(Hct)、血乳酸水平等,观察记录出血量、补液量及动物存活时间。结果根据实验设计,通过液体复苏使CHS组及UHS组大鼠院前期及医院救治期MAP分别维持在60mmHg及90mmHg。CHS组及UHS组同一时相MAP及CVP均无显著差异。院前期UHS组大鼠Hct明显低于CHS组。自院前期开始,UHS组大鼠血乳酸水平即持续性升高,而医院救治期以后CHS组血乳酸水平升高不明显。从医院救治期开始UHS组心率及最大心室内压上升速度明显低于CHS组。液体复苏后CHS组动物酸中毒及低氧血症得到明显纠正,但UHS组仍持续处于低氧血症及酸中毒状态。CHS组院前期补液量(44.5±10.1ml/kg)明显低于UHS组(74.5±11.4ml/kg,P<0.01)。CHS组及UHS组72h死亡率分别为30%及80%。结论较失血已控制的休克而言,对失血未控制的休克进行快速复苏可导致出血量增加、血液稀释、心功能损害及死亡率增加。
Objective To compare the effects of conventional liquid resuscitation on hemorrhagic shock in both uncontrolled blood loss and uncontrolled blood loss, and explore the countermeasures of early liquid resuscitation. Methods Totally 28 male SD rats were randomly divided into control group (n = 8), hemorrhagic shock control group (CHS group, n = 10) and uncontrolled blood loss group (n = 10). CHS group and UHS group rats femoral artery bleeding, the blood pressure within 15min to 30mmHg, and then cut off the tail of the three groups of rats, the control group and the CHS group immediately stop bleeding, untreated UHS group to make it natural bleeding. Simulated the actual situation of trauma, the animals were divided into pre-hospital (30 ~ 90min), hospital treatment (90 ~ 150min) and rehabilitation period (150min ~ 72h) three stages. Prehospital infusion of rat blood pressure was maintained at 60mmHg; hospital treatment ligation of hemorrhage, blood transfusion, infusion to maintain blood pressure to 90mmHg; convalescent observation to 72h. The mean arterial pressure (MAP), central venous pressure (CVP), cardiac function, blood gas analysis and hematocrit (Hct), blood lactate levels were monitored. The amount of bleeding, fluid volume and animal survival time were recorded. Results According to the experimental design, the MAP in the prehospital and hospital rescues of CHS group and UHS group were maintained at 60mmHg and 90mmHg respectively by liquid resuscitation. CHS group and UHS group at the same time MAP and CVP no significant difference. The prehospital UHS group rats Hct was significantly lower than the CHS group. Since the prehospital period, the level of blood lactic acid in UHS rats increased continuously, but the level of blood lactic acid in CHS group was not obvious after the hospital treatment. UHS group heart rate and maximum ventricular pressure rise rate was significantly lower than the CHS group from the start of hospital treatment. Acidosis and hypoxemia in CHS group were significantly corrected after fluid resuscitation, but the UHS group continued to be hypoxemia and acidosis. Pre-rehydration volume in CHS group (44.5 ± 10.1ml / kg) was significantly lower than that in UHS group (74.5 ± 11.4ml / kg, P <0.01). The 72h mortality rates in CHS group and UHS group were 30% and 80% respectively. CONCLUSIONS In contrast to hemorrhagic shocks that have been controlled, a rapid resuscitation of uncontrolled shock in the absence of blood loss can lead to increased bleeding, hemodilution, impaired cardiac function, and increased mortality.