不同比例的乳酸林格氏液/羟乙基淀粉的目标输液对休克犬凝血的影响

陶建平; 屈启才; 周臣; 思永玉; 杨家驹; 张军辉; 万林骏

不同比例的乳酸林格氏液/羟乙基淀粉的目标输液对休克犬凝血的影响

1. 昆明医科大学第二附属医院麻醉科
2. 昆明市中医院麻醉科
3. 昆明医科大学第二附属医院ICU

基金项目:

基金：国家自然科学基金资助项目 (81060033); 云南省教育厅科学研究基金资助项目 (2010Z030); 云南省卫生厅学科带头人培养计划基金资助项目 (D-201213);

计量
- 文章访问数: 2076
- HTML全文浏览量: 740
- PDF下载量: 85
- 被引次数: 5
出版历程
- 收稿日期: 2016-10-12

Effects of Goal-directed Fluid Therapy with Different Ratios of Lactated Ringer's/6% Hydroxyethyl Starch on Cogulation Function in Hemorrhagic Shock Dogs

Funds:

基金：国家自然科学基金资助项目 (81060033); 云南省教育厅科学研究基金资助项目 (2010Z030); 云南省卫生厅学科带头人培养计划基金资助项目 (D-201213);

摘要

摘要: 目的探讨不同比例的乳酸林格氏液/羟乙基淀粉的目标导向输液治疗对失血性休克犬凝血功能的影响.方法将48只健康比格犬随机分为6组 (n=8) :1个假手术对照组 (S组) 及5个实验组.S组仅实施气管内插管并持续泵入乳酸林格氏液与羟乙基淀粉各1 m L/ (kg·h) .实验组犬被制作成失血性休克模型后, 按液体复苏时输入乳酸林格氏液与羟乙基淀粉的比例不同随机分为5组:3∶1组、2∶1组、1∶1组、1∶2组及1∶3组.实验组犬的输液目标为每搏量变异度达到8%10%, 输血目标为血红蛋白达到1011 g/L.各组犬都被复苏并观察4 h.抽血检测实验前基础值 (T0) 、休克后1 h (T1) 、复苏2 h (T2) 及复苏4 h (T4) 时的凝血功能 (PT, APTT, TT及Fib) .术毕记录并统计乳酸林格氏液量、羟乙基淀粉液量、总输液量 (乳酸林格氏液量+羟乙基淀粉液量) 及尿量.结果各组各时点的凝血功能 (PT, APTT, TT及Fib) 的差异无统计学意义.1∶3组及1∶2组的羟乙基淀粉液量少于3∶1组;1∶3组及1∶2组的乳酸林格氏液量、总输液量和尿量少于3∶1组 (P<0.05) .结论乳酸林格氏液和6%羟乙基淀粉比例为3∶1, 2∶1, 1∶1, 1∶2和1∶3的目标输液并不影响失血性休克犬的凝血功能.
- 目标导向输液治疗 /
- 低血容量性休克 /
- 凝血功能
Abstract: Objective To investigate the effects of goal-directed fluid therapy with different ratios of Lactated Ringer's (LR) / Hydroxyethyl Starch (HES) on coagulation function in hemorrhagic shock dogs.Methods 48 healthy beagle dogs were randomly assigned to six groups (n=8) :sham group, 3∶1 group, 2∶1group, 1∶1 group, 1∶2 and 1∶3 group.Sham group (S group) just received endotracheal incubation.While3∶1 group, 2∶1 group, 1∶1 group, 1∶2 group and 1∶3 group were regarded as treatment groups.These treatment groups were administrated hemorrhagic shock model with bleeding and then resuscitated with goal-directedfluid therapy according to different LR/HES ratios: 3 ∶1, 2 ∶1, 1 ∶1, 1 ∶2 and 1 ∶3.Targeted goal of resuscitation is stroke volume variation (SVV) below 10%, a fluid bolus 2 m L/kg of different ratios was infused within 5 min when SVV exceed 10%.Autologous blood was administrated and the hemoglobin was maintained between 10 to 11 g/d L in treatment groups.The coagulation function test (PT, APTT, TT, and Fib) was measured at baseline (T0) , 1 h after shock (T1) , 2 h after resuscitation (T2) and 4 h after resuscitation (T4) .After 4 hours of fluid resuscitation, the total amounts of fluid (the LR amounts plus the HES amounts) and the urine output were recorded.Results There was no significant statistical difference in coagulation parameters (PT, APTT, TT, and Fib) in all groups at all time points.The HES amounts of the 1∶3 and 1∶2 groups were more than the 3∶1 group;the LR amounts, the total amounts of fluid, and the urine output in the 1∶3 and 1∶2groups were lower than in the 3∶1 group.Conclusion Different LR/HES (3∶1, 2∶1, 1∶1, 1∶2 and 1∶3.) ratios' goal-directed fluid therapy have no effect on the coagulation function of hemorrhagic shock dogs.
- Goal-directed fluid therapy /
- Hypovolemic shock /
- Coagulation

HTML全文

参考文献(18)

[1]	[1]YATES D R A, DAVIES S J, MILNER H E, et al.Crystalloid or colloid for goal-directed fluid therapy in colorectal surgery[J].British Journal of Anaesthesia, 2014, 112 (2) :281-289.
[2]	[2]SKHIRTLADZE K, BASE E M, LASSNIGG A, et al.Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer’s lactate on blood loss and coagulation after cardiac surgery[J].British Journal of Anaesthesia, 2014, 112 (2) :255-264.
[3]	[3]ANA L O, HELENA V, CARLOS V, et al.The in uence of Ringer's lactate or HES 130/0.4 administration on the integrity of the small intestinal mucosa in a pig hemorrhagicshock model under general anesthesia[J].J Vet Emerg Crit Care, 2016, 10 (4) :1-12.
[4]	[4]FRIES D, INNERHOFER P, KLINGLER A, et al.The effect of the combined administration of colloids and lactated Ringer's solution on the coagulation system:an in vitro study using thrombelastograph coagulation analysis (ROTEG) [J].Anesth Analg, 2002, 94 (5) :1280-1287.
[5]	[5]BUNDCAARD-NIELSON, HOLTE, SECHE, et al.Monitoring of perioperative fluid administration by individualized goal-directed therapy[J].Acta Anesiol Scand, 2007, 51 (3) :331-340.
[6]	[6]BENES J, CHYTRA I, ALTMANN P, et al.Intraoperative fluid optimization using stroke volume variation in high risk surgical patients:results of prospective randomized study[J].Crit Care, 2010, 14 (1) :R118.
[7]	[7]GOTTLIEB M, BAILITZ J.Comparison of early goal-directed therapy with usual care for severe sepsis and septic shock[J].Ann Emerg Med, 2015, 66 (6) :632-634.
[8]	[8]KELM D J, PERRIN J T, CARTIN-CEBA R, et al.Fluid overload in patients with severe sepsis and septic shock treated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death[J].Shock, 2015, 43 (1) :68-73.
[9]	[9]BOYT J H, FORBES J, NAKADA T, et al.Fluid resuscitation in septic shock:A positive fluid balance and elevated central venous pressure are associated with increased mortality[J].Critical Care Medicine, 2011, 39 (2) :259-265.
[10]	[10] DIANA J, KELM J T, PERRIN, et al.Fluid overfluid in patients with severve sepsis and septic shock threated with early goal-directed therapy is associated with increased acute need for fluid-related medical interventions and hospital death[J].SHOCK, 2015, 43 (1) :68-73.
[11]	[11]WINSTEDT D, HANNA J, SCHTT U, et al.Albumin-induced coaculapathy is less severe and more effectively reversed with fibrinogen concentrate than is synthetic colloid-induced coagulopathy[J].Scand J Clin Lab Invest, 2013, 73 (2) :161-169.
[12]	[12]ZDOLSEK H J, VEGFORS M, LINDAHL T L, et al.Hydroxyethyl starches and dextran during hipreplacement surgery:effects on blood volume and coahulation[J].2011, 55 (6) :677-685.
[13]	[13]SCHARBRT G, KOZEK-LANQENECKER S.Limitations of in vitro experiments on hydroxyethyl starch solutions[J].2007, 105 (3) :885-886.
[14]	[14]CHEN G, YAN M, LU Q H, et al.Effects of two different hydroxyethyl starch solutions (HES200/0.5 vs HES130/0.4) on the expression of platelet menbrane glycoprotein[J].Acta Anaes Scand, 2006, 50 (9) :1089-1094.
[15]游玉媛, 杨承祥, 李艳萍, 等.两种羟乙基淀粉不同程度血液稀释对凝血功能的影响[J].上海医学, 2009, 32 (1) :18-22.
[16]	[16]HUNG M H, ZOU C H, LIN F S, et al.New 6%hydroxyethyl starch 130/0.4 does not increase blood loss during major abdominal surgery-A randomized, controlled tria[J].Journal of the Formosan Medical Association, 2014, 113 (8) :429-435.
[17]	[17]MARTIN P, HERBERT S, CLAUDIA K, et al.Preferential effects of low volume versus high volume replacement with crystalloid fluid in a hemorrhagic shock model in pigs[J].BMC Anesthesiology, 2015, 133 (15) :1-10.
[18]	[18]RASMUSSEN K C, JOHNSSON P I, HOJSKOV M, et al.Hydroxyethyl starch reduces coagulation competence and increases blood loss during major surgery:Results from a randomized controlled trial[J].Annals Surgery, 2014, 259 (2) :249-254.

相关文章(20)

[1]	迟妍, 李俊娴, 赵玲, 李雯漪, 柯亭羽. 孕前不同BMI孕妇孕早期凝血及纤溶与妊娠期糖尿病的相关性, 昆明医科大学学报.
[2]	张忠强, 胡丽丽, 陈俊丽. 胸腔内注射凝血酶、引流管悬吊联合治疗难治性气胸的疗效, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240525
[3]	何海萍. 新型冠状病毒肺炎的老年患者的凝血功能指标分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240414
[4]	彭博, 苏纲, 秦榕, 温戎, 殷巍. 目标导向液体治疗联合米力农在腹腔镜肝叶切除手术中实现控制性低中心静脉压的观察, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20240918
[5]	李蕊, 李巧芬, 徐安书, 林闽明. 以培养目标为导向的教师临床带教能力多维度考评体系探索实践, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230803
[6]	刘晓雪, 李美菊, 夏婧. 下腔静脉变异度在脓毒性休克患者容量反应性评估中的价值, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230816
[7]	武彧, 杨德兴, 王虹, 王强, 周维钰, 唐杰夫, 王振方, 付凯, 刘荣. 脓毒性休克患者早期动、静脉血乳酸相关性及乳酸、乳酸清除率的预后评估价值, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210927
[8]	徐凡, 郭方圆, 何燕, 魏向群. 子宫腺肌病患者外周血血细胞及凝血功能的临床分析, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20211124
[9]	张琳, 李燕英, 孟琦, 李灿晖, 沈芸, 毕鸿雁, 杨秋萍, 熊悦. 老年2型糖尿病与血小板、凝血及纤溶功能的相关性, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20211110
[10]	和春霞, 刘志娟, 艾丽, 李永霞. 阻塞性睡眠呼吸暂停低通气患者的凝血功能, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20201235
[11]	唐欣, 孟繁媛, 陈茉弦, 王蕾, 徐璇, 赵洪波. 任务导向性训练对痉挛型偏瘫儿童上肢功能的效果, 昆明医科大学学报.
[12]	何红芬. 妇科肿瘤术后患者凝血功能变化的临床观察, 昆明医科大学学报.
[13]	刘波. 目标导向教学法在窝沟封闭技术实验课教学中的应用, 昆明医科大学学报.
[14]	蒋海燕. 目标导向液体治疗对高龄胃肠道肿瘤患者术后的影响, 昆明医科大学学报.
[15]	杨晓玲. 复发性流产患者凝血功能与流产次数的相关性, 昆明医科大学学报.
[16]	王枭. 集束化治疗对脓毒性休克恒河猴心肌损伤、血流动力学的影响, 昆明医科大学学报.
[17]	陶建平. 目标导向液体治疗对失血性休克犬输液量及肺水通道蛋白1、5的影响, 昆明医科大学学报.
[18]	吉鸿. 血栓弹力图指导下调节肝硬化脾切除围手术期凝血功能的临床观察, 昆明医科大学学报.
[19]	李未华. TIPS对肝硬化患者血流动力学及凝血功能的影响, 昆明医科大学学报.
[20]	. 家兔急性失血性休克及分组治疗的血压、微循环同步观测, 昆明医科大学学报.

施引文献

期刊类型引用(4)

1.	朱海涛，王丹丹，奉光举. 不同液体进行轻度急性等容性血液稀释对腰椎融合术患者血流动力学、血气及血栓弹力图指标的影响. 中国当代医药. 2021(08): 18-22+26 . 百度学术
2.	张侃，李世多，李亚东. 术前急性高容量血液稀释与乳酸林格氏液对食管癌患者输血量的影响. 实用癌症杂志. 2020(10): 1680-1683 . 百度学术
3.	武朱明，李勇，刘继松，章祥洲. 乳酸钠林格液在重度及特重度烧伤患者抗休克中改善低钠血症的效果. 安徽医学. 2019(04): 433-435 . 百度学术
4.	程新，陈伯成. 高温高湿环境下低温液体用于失血性休克患者的治疗研究进展. 智慧健康. 2019(13): 75-76+79 . 百度学术