【摘要】 目的:研究液体复苏联合早期血管活性药应用对感染性休克兔组织灌注的影响。方法:采用内毒素注射法制备兔感染性休克模型。48只大白兔随机均分为6组,设注射LPS前(T)、休克时(T0)、休克后30分(T1/2)、1h(T1)、2h(T2)、4h(T4)、6h(T6)共7个时间点,分别监测动物平均动脉压(MAP)、中心静脉压(CVP)、左室压力上升/下降最大速率(±dp/dtmax)变化,并检测动脉血浆中乳酸(LAC)浓度,计算各组6h乳酸清除率。结果:(1)各治疗组均能使MAP或CVP得到提升;休克后1h补液升压同时组MAP上升幅度显著高于其它治疗组(P均<0.05);T6时升压组、补液后升压组、升压后补液组、补液升压同时组差异无统计学意义(P均>0.05);补液组、补液后升压组、补液升压同时组的CVP在休克后2小时可恢复到休克前水平,而升压组、升压后补液组的CVP不能;±dp/dtmax在升压组、升压后补液组、补液升压同时组在1/2h、1h、2h均比对照组、补液组、补液后升压组高(P均<0.05),补液升压同时组最高;(2)LAC在治疗1h时开始出现回落,1h、2h时补液组、补液后升压组比升压组、升压后补液组LAC明显降低(P均<0.05),2h、4h、6h时补液升压同时组LAC显著低于其它治疗组(P均<0.05);(3)各组6小时乳酸清除率,补液升压同时组最高。结论:感染性休克治疗中,液体复苏、升压药独用或联合使用都可提升血压,提高组织灌注压,改善组织灌注与氧代谢,降低血乳酸水平,提高6小时血乳酸清除率。更多还原

【Abstract】 Objective:To evaluate t he changes on concentrations of tissue perfusion after the fluid resuscitation combined with early application of vasopressor in rabbits with septic shock. Methods:Models of rabbits with septic shock were replicated by endotoxin injection. Forty-eight rabbits with septic shock were randomly divided into six groups: the control group, the fluid infusion group, the vasopressor group, the vasopressor after fluid infusion group, the fluid infusion after vasopressor group, and the fluid infusion with vasopressor group. Blood was collected for seven times, before injecting LPS(T), 0h(T0) before septic shock and 1/2h(T1/2), 1h(T1), 2h(T2), 4h(T4), and 6h(T6) after treatment, in order to detect the changes of the mean arterial pressure(MAP), the central venous pressure(CVP), the rising/falling maximum rate of left ventricular pressure(±dp/dtmax) and the concentrations of LAC and calculate 6h blood lactic acid clearance rate of the six groups. Results:(1) MAP or CVP in all the treatment groups could be enhanceed; MAP of fluid infusion in the vasopressor group was significantly higher than that in the other treatment groups at 1h after shock(P all <0.05); at T6 there was no significant difference(P all> 0.05)in the vasopressor group, the vasopressor after fluid infusion group and the fluid infusion with vasopressor group; CVP in the fluid infusion group, the vasopressor after fluid infusion group and the fluid infusion with vasopressor group could recover to the preshock level at 2 hours after the shock, while in the vasopressor group and the fluid infusion after vasopressor group could not; ±dp/dtmax were higher in the vasopressor group, the fluid infusion after vasopressor group and the fluid infusion with vasopressor group than in the control group, the fluid infusion group, the vasopressor after fluid infusion group at 1/2h, 1h, 2h(P all> 0.05), and in the fluid infusion with vasopressor group it was the highest;(2) LAC began to reduce at 1h after the treatment, and at 1h and 2h LAC in the fluid infusion group, and the vasopressor after the fluid infusion group was significantly lower(P all <0.05)than in the vasopressor group and the fluid infusion after vasopressor group, and at 2h, 4h and 6h LAC in the fluid infusion with vasopressor group was significantly lower than in the other treatment groups(P all <0.05);(3) In all groups, 6h blood lactic acid clearance rate of fluid infusion with vasopressor group is the highest. Conclusions:In the treatment of septic shock, fluid resuscitation,application of vasopressor alone or in combination can all raise blood pressure, elevate tissue perfusion pressure, improve tissue perfusion and oxygen metabolism, lower blood lactate levels, increase blood lactate clearance rate of 6 hours. In this study, 6 hours of lactic acid after resuscitation as an index, fluid resuscitation combined with early application of vasopressor was the best of the five programs, and vasopressor alone was the worst.更多还原