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目的比较3种不同分子量的6%羟乙基淀粉(HES)/0.9%氯化钠(NaCl)溶液对大鼠非控制出血性休克的早期低压复苏效果。方法采用脾脏损伤+切断脾动脉的一分支造成大鼠非控制出血性休克模型,32只Sprague-Dawley(SD)大鼠按照止血前输注液体的不同分为4组:Ⅰ组,不复苏(no resuscitation,NR)组;Ⅱ组,HES40组;Ⅲ组,HES130组;Ⅳ组,HES200组。伤后平均动脉压(MAP)降至40mmHg时各组分别用3种不同的6%HES/0.9%Nacl溶液开始进行低压复苏,使MAP维持在50mmHg,持续1小时(低压期),Ⅰ组此期不输注任何液体。然后结扎脾动脉止血,各组均以林格氏液加肝素化的供体大鼠全血进行充分液体复苏2小时。观察血流动力学、出血量、血细胞比容(Hct)、止血前期和止血后期的输液量、存活时间。结果与Ⅰ组比较,早期低压复苏虽然增加了出血量,却显著延长了存活时间,其中Ⅲ、Ⅳ组存活时间比Ⅱ组显著延长,且止血前和止血后输液量显著少于Ⅱ组,而Hct显著高于Ⅱ组,其改善血流动力学的作用显著强于Ⅱ组。结论用HES进行低压复苏,较之不复苏延长了非控制出血性休克大鼠的存活时间。不同分子量的HES复苏效果不同,HES130和HES200的复苏效果优于HES40。
Objective To compare the effects of 3 different HES / 0.9% sodium chloride (NaCl) solutions with different molecular weights on early low pressure resuscitation in uncontrolled hemorrhagic shock in rats. Methods Sprague-Dawley (SD) rats were divided into 4 groups according to the different types of pre-hemostatic fluids: group Ⅰ without resuscitation no resuscitation, NR) group; groupⅡ, group HES40; groupⅢ, group HES130; groupⅣ, group HES200. After the injury, mean arterial pressure (MAP) decreased to 40mmHg, the rats in each group began to perform low-pressure resuscitation with 3 different 6% HES / 0.9% Nacl solutions respectively, keeping the MAP at 50mmHg for 1 hour (low pressure) Do not infuse any fluid. Then ligation of the splenic artery to stop bleeding, each group with Ringer’s solution plus heparinized donor rat whole blood for adequate liquid resuscitation for 2 hours. Hemodynamics, bleeding volume, hematocrit (Hct), transfusion volume and survival time in the pre-hemostatic and hemostatic phases were observed. Results Compared with group Ⅰ, early hypobaric resuscitation increased the amount of bleeding, but significantly prolonged the survival time. The survival time in group Ⅲ and Ⅳ was significantly longer than that in group Ⅱ, and the amount of transfusion was significantly less than that in group Ⅱ before and after hemostasis Hct was significantly higher than that of group Ⅱ, and its effect of improving hemodynamics was significantly stronger than that of group Ⅱ. Conclusions HES for low-pressure resuscitation prolongs the survival time of uncontrolled hemorrhagic shock rats compared with non-resuscitation. HES resuscitation with different molecular weight has different effect, HES130 and HES200 recovery better than HES40.