【摘要】 目的 探讨在失血性休克时静脉输入不同剂量6％羟乙基淀粉（HES）对血液动力学的影响。方法 成年健康杂种犬15只,体重12～20kg,随机分为三组,每组5只。静脉麻醉后放血使平均动脉压（MAP）降至5.3 kPa,造成失血性休克。然后Ⅰ、Ⅱ、Ⅲ组分别按放血量的1/2、2/3或等量静脉快速输入6％HES。监测放血前（T₀）、休克时（T₀）、输入6％HES后 5（T₂）、30（T₃）和60min（T₄）的心率（HR）、MAP、肺动脉压（PAP）、肺动脉嵌压（PAWP）、中心静脉压（CVP）、心排血量（CO）、心脏指数（CI）和体循环阻力（SVR）。结果 （1）三组休克犬在快速输入6％HES后,各组MAP、CO、CI均显著回升（P<0.01）,上升幅度Ⅲ组>Ⅱ组>Ⅰ组,其中Ⅱ组达基础值水平,Ⅲ组CO、CI显著高于基础值（P<0.01）,并维持60 min以上。PAP、PAWP均显著回升高于基础值（P<0.05或P<0.01）,持续达60 min以上。休克时,三组的SVR均显著升高（P<0.05）,在输入6％HES后显著下降。结论 以失血量的1/2、2/3或等量快速输入6％HES均可显著提高实验犬的血液动力学各项指标,但以失血量的2/3或等量HES快速输入扩容效果更为理想。更多还原

【Abstract】 Objective To investigate the effects of infusin different dosage of 6 % hydroxyethyl starch( HES) on hemodynamics during hemorrhagic shock. Methods Twelve mongrel dogs were randomized to one of the three groups with five dogs each. After intravenous anesthesia, shock was induced with arteria femoralis bleeding to make MAP falling to 5. 3 kPa. HES was infused in an amaunt of 1/3 blood lose in group Ⅰ ,of 2/3 that in group Ⅱ,or equal to blood lose in group Ⅲ. The changes of HR, MAP, PAP, PAWP, CVP, CO, CI, and SVR were measured before bleeding (T0), during shock(T1),at 5 min after the infusion of HES(T2),30 min(T3),and 60 min(T4). Results After infusion of HES, MAP,CO and CI were increased significantly(P<0. 01)in an order of Ⅲ >Ⅱ >Ⅰ . CO and CI were higher than the baseline levels, and lasted for more than 60 min. PAP and PAWP were increased. SVR increased significantly during shock and declined after HES infusion in all three groups. Conclusions Rapidly infusing 6% HES in an amaunt of 1/2,2/3 or equal to the blood lose is all effective in improving the hemodynamics in the hemorrhagic shock dogs. The improvement of the hemodynamics is better when HES of 2/3 or equal amount of blood lose is infused.更多还原