Qin Wei, Yu Yan-Hong, Wang Chen-Hong
Department of Obstetric, Maternal and Child Health Hospital, Southern Medical University, Shenzhen 518028, China.
Zhonghua Fu Chan Ke Za Zhi. 2010 Oct;45(10):775-80.
to study the effects of hypotensive resuscitation on microvascular perfusion in a clinically relevant model of uncontrolled hemorrhagic shock in pregnancy.
thirty New Zealand white rabbits at 15 - 25 days, pregnanal age were randomly divided into three groups; Group normal saline traditional aggressive resuscitation (NS), traditional aggressive resuscitation in the prehospital phase with a large quantity of normal saline and Ringer's solution to maintain mean arterial pressure (MAP) at the approximately 80 mm Hg (1 mm Hg = 0.133 kPa) level: Group normal saline hypotensive resuscitation (NH) and group hypertonic hyperosmotic hypotension resuscitation (HHH), hypotensive resuscitation in the prehospital phase with a bolus dose of 4 ml/kg normal saline or hypertonic hydroxyl ethyl starch (10% hydroxyl ethyl starch +7.5% NaCl), followed by Ringer's solution to maintain MAP at 60 mm Hg. Production pregnant rabbit model with hemorrhagic shock. The experiment consisted of four phases:basic phase (0 miniutes), shock phase (0 - 30 miniutes), prehospital phase (30 - 90 miniutes) and hospital phase (90 - 180 miniutes).
(1) arteriole and venule diameter were continuously monitored by microcirculatory detecting instrument; (2) functional capillary density (FCD) of each phase was expressed by the percentage of opening capillaries segments relative to basic phase; (3) blood pH, BE PCO(2), PO(2) in pregnant rabbits were determined with a Medica Easy Blood Gas Analyzer.
(1) there were no significant differences among three groups in arteriole and venule diameter at baseline (P > 0.05). After hemorrhagic shock arteriole diameter were NS (50.8 ± 5.6) µm, NH (47.6 ± 3.7) µm, HHH (51.3 ± 2.4) µm, respectively, with no significant differences between groups (P > 0.05). At the end of prehospital resuscitation phase and hospital resuscitation phase, significant differences were found in arteriole diameter in group NS (52.8 ± 4.9, 56.0 ± 3.8) µm, NH (61.3 ± 2.9, 65.4 ± 3.2)µm and HHH group (67.0 ± 4.1, 74.1 ± 4.8) µm (P < 0.05); after hemorrhagic shock venule diameter were NS (79.6 ± 7.0) µm, NH (75.3 ± 5.3) µm and HHH (76.2 ± 5.8) µm, respectively, with no significant differences between groups (P > 0.05). At the end of prehospital resuscitation phase and hospital resuscitation phase, venule diameter were NS (81.1 ± 6.7, 84.4 ± 6.0) µm, NH (82.8 ± 3.3, 85.4 ± 4.3) µm and HHH (86.9 ± 5.8, 89.4 ± 6.8) µm, respectively, with no significant differences between groups (P > 0.05). (2) The values of FCD in every groups were all 100%. After hemorrhagic shock FCD were NS (39.8 ± 6.8)%, NH (43.9 ± 4.0)%, HHH (44.0 ± 4.8)%, respectively, with no significant differences between groups (P > 0.05); at the end of prehospital resuscitation phase and hospital resuscitation phase, FCD were NS (54.5 ± 7.3, 59.7 ± 4.8)%, NH (63.1 ± 5.8, 70.3 ± 5.6)% and HHH (80.5 ± 6.9, 91.7 ± 4.7)%, respectively, with significant differences between groups (P < 0.05). (3) Blood gas parameter: the values of blood pH, BE, PO(2), PCO(2) in pregnant rabbits in all groups were within normal bounds at basic phase. Shock phase induced typical hyperventilation in all groups, with increase of arterial PO(2) and decrease of PCO(2); at the end of hospital resuscitation phase, there were no significant difference among the three groups in the values of blood PCO(2) (P > 0.05); the values of blood PO(2) at the hospital resuscitation phase were significantly lower in NS groups than corresponding values in the other groups (P < 0.05). After hemorrhagic shock there was significant metabolic acidosis as shown by decrease of pH, BE; at prehospital resucitation phase, pH, BE values tended to increase in all the groups but not reach to base period. At the end of hospital resucitation phase. The pH, BE value was significantly higher in NS group than those in the other two groups (P < 0.05). (4) Median survival time in NS (2.1 ± 0.2) days group was significantly shorter than NH (3.0 ± 0.3) days and HHH (3.6 ± 0.3) days group (P < 0.05). FCD at the end of the hospital resuscitation were significantly related with survival time (r = 0.655, P = 0.000).
compared with traditional aggressive fluid resuscitation, hypotensive resuscitation reduce constriction of arterial and venule diameter, increase FCD, alleviate metabolic acidosis and improve long-term survival. Hypertonic hydroxyl ethyl starch resuscitation ameliorate microcirculation without improving survival rate.
在临床相关的妊娠未控制失血性休克模型中研究降压复苏对微血管灌注的影响。
将30只孕龄15 - 25天的新西兰白兔随机分为三组；生理盐水传统积极复苏组（NS），在院前阶段用大量生理盐水和林格氏液进行传统积极复苏，以维持平均动脉压（MAP）在约80 mmHg（1 mmHg = 0.133 kPa）水平；生理盐水降压复苏组（NH）和高渗高张性低血压复苏组（HHH），院前阶段先静脉推注4 ml/kg生理盐水或高渗羟乙基淀粉（10%羟乙基淀粉 + 7.5%氯化钠）进行降压复苏，随后用林格氏液维持MAP在60 mmHg。制作孕兔失血性休克模型。实验分为四个阶段：基础阶段（0分钟）、休克阶段（0 - 30分钟）、院前阶段（30 - 90分钟）和院内阶段（90 - 180分钟）。
（1）用微循环检测仪连续监测小动脉和小静脉直径；（2）各阶段的功能性毛细血管密度（FCD）用开放毛细血管段相对于基础阶段的百分比表示；（3）用Medica Easy血气分析仪测定孕兔血液pH、碱剩余（BE）、二氧化碳分压（PCO₂）、氧分压（PO₂）。
（1）三组在基线时小动脉和小静脉直径无显著差异（P > 0.05）。失血性休克后，NS组小动脉直径为（50.8 ± 5.6）μm，NH组为（47.6 ± 3.7）μm，HHH组为（51.3 ± 2.4）μm，组间无显著差异（P > 0.05）。在院前复苏阶段末和院内复苏阶段末，NS组小动脉直径分别为（52.8 ± 4.9）μm、（56.0 ± 3.8）μm，NH组为（61.3 ± 2.9）μm、（65.4 ± 3.2）μm，HHH组为（67.0 ± 4.1）μm、（74.1 ± 4.8）μm，差异有统计学意义（P < 0.05）；失血性休克后，NS组小静脉直径为（79.6 ± 7.0）μm，NH组为（75.3 ± 5.3）μm，HHH组为（76.2 ± 5.8）μm，组间无显著差异（P > 0.05）。在院前复苏阶段末和院内复苏阶段末，NS组小静脉直径分别为（81.1 ± 6.7）μm、（84.4 ± 6.0）μm，NH组为（82.8 ± 3.3）μm、（85.4 ± 4.3）μm，HHH组为（86.9 ± 5.8）μm、（89.4 ± 6.8）μm，组间无显著差异（P > 0.05）。（2）各组FCD值均为100%。失血性休克后，NS组FCD为（39.8 ± 6.8）%，NH组为（43.9 ± 4.0）%，HHH组为（44.0 ± 4.8）%，组间无显著差异（P > 0.05）；在院前复苏阶段末和院内复苏阶段末，NS组FCD分别为（54.5 ± 7.3）%、（59.7 ± 4.8）%，NH组为（63.1 ± 5.8）%、（70.3 ± 5.6）%，HHH组为（80.5 ± 6.9）%、（91.7 ± 4.7）%，组间差异有统计学意义（P < 0.05）。（3）血气参数：各组孕兔在基础阶段血液pH、BE、PO₂、PCO₂值均在正常范围内。休克阶段所有组均出现典型的过度通气，动脉PO₂升高，PCO₂降低；在院内复苏阶段末，三组血液PCO₂值无显著差异（P > 0.05）；NS组在院内复苏阶段的血液PO₂值显著低于其他组（P < 0.05）。失血性休克后出现明显的代谢性酸中毒（pH、BE降低）；在院前复苏阶段，所有组pH、BE值均有上升趋势，但未恢复到基础期水平。在院内复苏阶段末，NS组pH、BE值显著高于其他两组（P < 0.05）。（4）NS组中位生存时间为（2.1 ± 0.2）天，显著短于NH组（3.0 ± 0.3）天和HHH组（3.6 ± 0.
