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脾切除术对固定容量犬失血性休克血流动力学表现的影响。

Effects of splenectomy on hemodynamic performance in fixed volume canine hemorrhagic shock.

作者信息

Hoekstra J W, Dronen S C, Hedges J R

机构信息

Department of Emergency Medicine, University of Cincinnati Medical Center, Ohio 45267-0769.

出版信息

Circ Shock. 1988 Jun;25(2):95-101.

PMID:3390894
Abstract

Studies of canine hemorrhagic shock commonly use a splenectomized fixed-pressure model. Splenectomy is recommended in this model to avoid variable degrees of autotransfusion that reduce the reliability of mortality estimates and blood volume measurements. The effects of splenectomy on a non-lethal fixed-volume canine hemorrhage have not been established. The purpose of this study was to investigate cardiovascular and biochemical effects of splenectomy in fixed-volume canine hemorrhagic shock. Nineteen beagles of uniform size and weight were bled 50% of their estimated blood volumes over 1 hr and then left without therapeutic intervention for a 90 min stabilization period. Arterial blood pressure (MAP), central venous pressure, pulmonary artery pressure, heart rate (HR), cardiac output, glucose, lactate, arterial and mixed venous blood gases, and hematocrit (HCT) were measured at regular intervals. Cardiac index (CI), stroke volume, and oxygen saturation (O2SAT), delivery (O2DEL) and consumption (O2CON) were calculated at these intervals. Results from ten control animals were compared to those from nine animals that had been splenectomized 2 wk prior to hemorrhage. During the hemorrhage period, there were no significant differences observed between groups for HR, MAP, or O2DEL. CI remained higher (P less than 0.025) and HCT lower (28.9 +/- 4.7 vs 39.8 +/- 4.5) (P less than 0.001) in splenectomized animals. Immediately following hemorrhage there were no significant differences in the mean values for HR, CI, MAP, or serum lactate. O2DEL however, was significantly higher in control animals (P less than 0.05). During stabilization MAP, CI, and O2DEL rose while HCT fell in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

犬失血性休克的研究通常采用脾切除固定压力模型。在该模型中建议进行脾切除术,以避免不同程度的自体输血,这种自体输血会降低死亡率估计和血容量测量的可靠性。脾切除术对非致死性固定容量犬出血的影响尚未明确。本研究的目的是调查脾切除术在固定容量犬失血性休克中的心血管和生化影响。19只大小和体重一致的比格犬在1小时内失血达估计血容量的50%,然后在无治疗干预的情况下进行90分钟的稳定期观察。定期测量动脉血压(MAP)、中心静脉压、肺动脉压、心率(HR)、心输出量、葡萄糖、乳酸、动脉血和混合静脉血气以及血细胞比容(HCT)。在这些时间点计算心脏指数(CI)、每搏输出量以及氧饱和度(O2SAT)、输送量(O2DEL)和消耗量(O2CON)。将10只对照动物的结果与9只在出血前2周进行脾切除的动物的结果进行比较。在出血期间,两组之间在HR、MAP或O2DEL方面未观察到显著差异。脾切除动物的CI保持较高水平(P小于0.025),HCT较低(28.9±4.7对39.8±4.5)(P小于0.001)。出血后立即,HR、CI、MAP或血清乳酸的平均值无显著差异。然而,对照动物的O2DEL显著更高(P小于0.05)。在稳定期,两组的MAP、CI和O2DEL均升高,而HCT下降。(摘要截短至250字)

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