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[实验性止血带休克中的血流动力学与心肌收缩力]

[Hemodynamics and myocardial contractility in experimental tourniquet-shock].

作者信息

Stock W, Geppert E, Haase W, Isselhard W

出版信息

Basic Res Cardiol. 1976 Mar-Apr;71(2):133-49. doi: 10.1007/BF01927866.

Abstract

A reproducible tourniquet-shock has been produced in hind limbs of dogs by unilateral and bilateral extremity ischemia. The following parameters have been measured for analysing the function of the cardiovascular system: mean aortic pressure, heart rate, cardiac output, intraventricular pressure and left ventricular pressure. From these data the stroke volume, stroke work, total peripheral resistance and the parameters of heart contractility dp/dtmax, dp/dtmax:IP and t-dp/dtmax were derived. During the ischemic period all circulatory parameters did not change in comparison to the controls. A tourniquet-shock developed upon recirculation of the ischemically stressed extremity which was more pronounced after bilateral than after unilateral hind leg ischemia. After release of the tourniquet all animals with unilateral tourniquet survived an observation period of 5 hours duration, whereas 6 out of 8 dogs with bilateral tourniquet died of heart failure. Upon release of the tourniquet, the cardiac output raised up to 140% of the normal value: the abruptly decreasing aortic pressure was fully compensated by a tachycardia from 100 to 190 (beats/minute). The parameters dp/dtmax:IP and t-dp/dtmax indicated a distinct increase of the left ventricular contractility in the early tourniquet-syndrom. Already after 30 minutes an increasing circulatory depression developed indicative of the decrease in aortic pressure, and enddiastolic pressure. At the same time an increase of heart rate and total peripheral resistance occurred. The parameters of left ventricular contractility did not change markedly during the course of shock except for the final stage.

摘要

通过单侧和双侧肢体缺血在犬后肢产生了可重复性的止血带休克。为分析心血管系统功能,测量了以下参数:平均主动脉压、心率、心输出量、心室内压和左心室压。根据这些数据得出了每搏量、每搏功、总外周阻力以及心脏收缩力参数dp/dtmax、dp/dtmax:IP和t-dp/dtmax。在缺血期,与对照组相比,所有循环参数均未改变。在缺血应激肢体再灌注时出现了止血带休克,双侧后腿缺血后比单侧后腿缺血后更为明显。松开止血带后,所有单侧止血带的动物在5小时的观察期内存活,而8只双侧止血带的犬中有6只因心力衰竭死亡。松开止血带后,心输出量增加至正常值的140%:主动脉压的突然下降通过心率从100次/分钟增加到190次/分钟得到了充分补偿。参数dp/dtmax:IP和t-dp/dtmax表明在早期止血带综合征中左心室收缩力明显增加。30分钟后就出现了循环抑制加重,表现为主动脉压和舒张末期压力降低。同时心率和总外周阻力增加。除了休克末期,左心室收缩力参数在休克过程中没有明显变化。

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