液体复苏对初进高海拔地区重度失血性休克犬肺形态学的影响

摘要

Objective To investigate the effects of fluid resuscitation on pulmonic morphology of dogs with hemorrhagic shock at initial stage of ascending high altitudes. Methods 13 mongrel dogs were randomly divided into 3 groups after arriving at high altitudes. The control group received no treatment after fall in hemorrhagic shock (n =3), the LR group (n =5)was treated by intravenous transfusion of balanced solution in 1.5 times volume of lost blood, and the HAES group (n =5)was given HAES steril in equal volume. Both groups sustained transfusion of balanced solution at 5 ml/(kg·H)after resuscitation. All animals were sacrificed by exsanguination 48 h after resuscitation and the morphological changes of lungs were pathologically observed. Results The dogs in control group were all dead 2 hours after shock and were not included in statistical analysis. The lung weight/body weight index and semi-quantitative scores of histopathological changes in LR group and HAES group were (0. 78 ±0. 14)%, (1.25 ± 0.38)and (1.03 ± 0.27)% , (3. 85 ± 0.48), and there were significant difference in two groups (P < 0. 05 ). The micro-structure of lung tissues were observed under the light microscope, the results showed an apparent interstitial pulmonary edema, and alveolar pulmonary edema in HAES group. Conclusion The dogs with hemorrhagic shock at initial stage of ascending high altitudes must be treated with fluid resuscitation, otherwise, the death rate would be 100%. 1.5 times transfusion of balanced solution can prevent pulmonic edema. Transfusion of equal volume of HAES steril 200/0.5 failed in preventing pulmonic edema.%目的 探讨液体复苏对初进高海拔地区重度失血性休克犬肺形态学的影响.方法 13只成年杂种犬进入高海拔地区后随机分为对照组3例、平衡液组(LR组)5例及羟乙基淀粉组(HAES组)5例,对照组休克后不进行液体复苏,LR组输入1.5倍失血量的平衡液,HAES组输入等失血量的中分子羟乙基淀粉200/0.5,然后以5 ml/(kg·h)输注平衡液作为维持量,实验犬观察至复苏后48h放血处死,观察肺形态学变化.结果 对照组在休克后2h全部死亡,未列入数据统计.LR组肺重系数及肺损伤病理半定量评分分别为(0.78±0.14)％、(1.25±0.38)分,HAES组分别为(1.03±0.27)％、(3.85±0.48)分,两组比较差异有统计学意义(P＜0.05).LR组光镜下呈间质期肺水肿改变,HAES组光镜下呈肺泡性肺水肿改变.结论 初进高海拔地区的重度失血性休克犬,如不能进行有效的液体复苏,死亡率达100％.输入1.5倍平衡液进行液体复苏未发生明显的肺水肿,而输入等失血量的中分子羟乙基淀粉200/0.5则发生了明显的肺水肿,原因有待进一步证实.