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目的探讨失血性休克兔容量治疗的合理方案。方法采用正交实验设计确立实验因素为输液种类(A)、输液剂量(B)和输液时机(C);实验水平数为三水平,A1、A2、A3分别为6%羟乙基淀粉、生理盐水、林格氏液,B1、B2、B3输液剂量分别为5、10、20 ml/kg,C1、C2、C3分别为休克前、代偿期、失代偿期。应用L9(34)正交表。27只健康新西兰大白兔,经颈内静脉缓慢放血(5-6 ml/min),直至MAP下降30%,建立失血性休克模型。根据正交表顺序进行实验。输液后由颈内静脉注入伊文思蓝,3 h后处死兔。测定肺组织含水率、伊文思蓝含量,并观察肺组织学改变。结果输液种类是影响失血性休克兔肺毛细血管渗漏的主要因素,其次为输液剂量,再次为输液时机。直观分析结果表明最优输液方案为A1B3C2。肺组织病理学结果显示,A1B3C2组肺损伤最轻,其它由轻到重依次为A1B2C2、A3B3C2、A1B3C3、A3B2C1、、A2B2C3、含B1的三组,A2B3C1肺损伤最重。结论失血性休克兔6%HES 20 ml/kg于休克代偿期输入产生效果最好。
Objective To investigate the reasonable solution of volumetric treatment of hemorrhagic shock in rabbits. Methods The orthogonal experiment design was used to establish the experimental factors of infusion type (A), infusion dose (B) and infusion timing (C); the experimental level was three levels, A1, A2 and A3 were 6% hydroxyethyl starch, Saline, Ringer’s solution, B1, B2, B3 infusion dose were 5,10,20 ml / kg, C1, C2, C3 were shocked before, compensatory, decompensated. Apply L9 (34) orthogonal table. Twenty-seven healthy New Zealand white rabbits were slowly exsanguinated (5-6 ml / min) through the internal jugular vein until the MAP decreased by 30%. A hemorrhagic shock model was established. According to the order of orthogonal table experiment. After infusion, Evans blue was injected into the jugular vein and rabbits were sacrificed 3 h later. The water content of the lung tissue, Evans blue content were measured, and the lung histological changes were observed. Results Infusion type is the main factor affecting pulmonary capillary leakage in hemorrhagic shock rabbits, followed by infusion dose, again infusion timing. Intuitive analysis showed that the optimal infusion solution was A1B3C2. Lung histopathological results showed that the lung injury in A1B3C2 group was the lightest, and that in the other groups were A1B2C2, A3B3C2, A1B3C3, A3B2C1, A2B2C3 and B1, and A2B3C1 had the highest lung injury. Conclusions Hemorrhagic shock rabbit 6% HES 20 ml / kg has the best effect on shock compensatory input.