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);

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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

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参考文献(18)

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