天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (1): 27-31.doi: 10.11958/20170522

• 实验研究 • 上一篇    下一篇

以 SvO2为导向的早期目标导向液体治疗对感染性 休克猪血流动力学和氧动力学的影响

李佳男 1，杜薇 2，曹惠鹃 1，刁玉刚 1，张铁铮 1△   

  1. 1 沈阳军区总医院麻醉科（邮编 110016）；2 辽宁省肿瘤医院麻醉科
  • 收稿日期:2017-04-28 修回日期:2017-11-06 出版日期:2018-01-15 发布日期:2018-01-16
  • 通讯作者: 李佳男 E-mail:1012612805@qq.com
  • 作者简介:李佳男（1988），女，硕士，医师，主要从事液体治疗方面研究
  • 基金资助:
    军队后勤科研项目

The effect of SvO2-guided early goal directed fluid therapy on hemodynamic and oxygen dynamics in septic shock pig model

LI Jia-nan1, DU Wei2, CAO Hui-juan1, DIAO Yu-gang1, ZHANG Tie-zheng1△   

  1. 1 Department of Anesthesiology, General Hospital of Shenyang Military Region, Shenyang 110016，China; 2 Department of Anesthesiology, Liaoning Cancer Hospital
  • Received:2017-04-28 Revised:2017-11-06 Published:2018-01-15 Online:2018-01-16

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摘要： 目的 评价以混合静脉血氧饱和度（SvO2）为导向的早期目标导向液体治疗（EGDT）对感染性休克猪血流 动力学和氧动力学的影响。方法 雄性巴马小型猪 12 只，采用随机数字表法均分为传统方法（C）组和目标导向（G） 组。采用静脉输注内毒素方法制造感染性休克模型后，C 组休克后维持平均动脉压（MAP）≥65 mmHg，中心静脉压 （CVP）8~12 mmHg，尿量≥0.5 mL/ （kg·h），G 组除以上指标外，维持 SvO2≥0.65。治疗持续 6 h。分别在内毒素开始输 注 0、60、120、180、240、300、360、420 及 480 min（T0~T8）记录中心体温、血流和氧动力学指标及使用的液体和血管活 性药物使用情况。结果 与 C 组相比，在血流动力学方面 2 组各时点 MAP、心率（HR）、全身血管阻力指数（SVRI）差 异无统计学意义（P＞0.05），G 组在 T4~T8 时点心输出量指数（CI）和 CVP 升高（P＜0.05），在 T8 时点平均肺动脉压 （MPAP）和肺血管阻力指数（PVRI）降低（P＜0.05）；在氧动力学方面，G 组在 T3~T8 时点 SvO2升高，氧摄取率（O2ER） 降低（P＜0.05），在 T4~T8 时点氧供（DO2）升高（P＜0.05），T5~T8 时点血乳酸（Lac）降低，在 T8 时点动静脉 CO2分压 差［Δp（CO2）］降低（P＜0.05），2 组动物各时点氧耗（VO2）差异无统计学意义（P＞0.05）。G 组补液量和尿量多，去甲肾上 腺素量较少（P＜0.05），G 组多巴酚丁胺用量较多，而 C 组均未用。结论 以 SvO2为导向的 EGDT 在感染性休克救治 中可更加有效地稳定血流动力学和氧动力学，表现为心输出量增加、氧供增加、氧摄取率正常、组织灌注较好。

关键词: 疾病模型, 动物, 感染性休克, 血流动力学, 氧动力学, 混合静脉血氧饱和度, 早期目标导向治疗

Abstract: Objective To evaluate the effect of SvO2-guided early goal directed fluid therapy on hemodynamic and oxygen dynamics in septic shock pig model. Methods Twelve Bama miniature pigs (male, 21-24 kg) were equally randomized into 2 groups, group C and group G. Septic shock was induced by intravenous infusion endotoxin. Group C received hemodynamic support aiming central venous pressure at 8 to 12 mmHg, urinary output 0.5 mL/kg per hour, and mean arterial pressure greater than 65 mmHg. Group G maintained SvO2 greater than 0.65 in addition to the above indicators. The interventions lasted 6 h and at T0-T8 (0, 60, 120, 180, 240, 300, 360, 420 and 480 min) recorded temperature, hemodynamic and oxygen dynamics indexes for each group, and recorded 6 hours for accumulated liquid volume, vascular active drug, and changes of urine. Results There were no significant differences in mean arterial blood pressure (MAP), heart rate (HR) and systemic vascular resistance index (SVRI) at each time point between group G and group C (P＞0.05). Values of CI and CVP were increased at T4-T8 in group G (P＜0.05). Values of MPAP and PVRI were decreased at T8 in group G (P＜0.05). Values of SvO2 were increased at T3-T8, O2ER were decreased at T3-T8 (P＜0.05), DO2 were increased at T4-T8 (P＜0.05), Lac were decreased at T5-T8, and Δp(CO2) was decreased at T8 in group G (P＜0.05). There were no significant differences in values of VO2 at T1-T8 between two groups (P＞0.05). The amount of intravenous infusion and urine volume were more and the amount of norepinephrine was less in animals of group G (P＜0.05). The dosage of　dobutamine was more in animals of group G, and which was not used in animals of group C. Conclusion SvO2 guided fluid therapy is more effective than conventional treatment to stabilize hemodynamics and oxygen kinetics, which is characterized by the increased cardiac output, increased oxygen supply, normal oxygen uptake rate and good tissue perfusion.

Key words: disease models, animal, septic shock, hemodynamics, oxygen kinetics, SvO2, EGDT