中心静脉血氧饱及度用于失血性休克输血监测探究.doc

中心静脉血氧饱及度用于失血性休克输血监测探究[摘要] 目的 研究中心静脉血氧饱和度（ScvO2）在失血性休克兔休克复苏过程中作为输血指标与传统输血指标的比较。 方法 选择新西兰纯系家兔24只，随机分为3组，A、B两组为观察组，C组为对照组，每组8只。A、B、C三组分别以ScvO2≤70%、 ScvO2≤75%、血红蛋白（Hb）≤8g/dL为输血指征。从股动脉放血，10min内使MAP降到约(40±5)mmHg，并维持血压60min，建立失血性休克兔的动物模型。然后开始复苏，用胶体液和晶体液基本按1：2的比例输注，输注速度约为(10～15)mL/(kg?h)，根据血压、心率适当调节，并按照每组的不同要求进行输血。监测基础值、休克时、休克治疗30、60、120、180min各个时间点的各项指标以及失血量、输血量、输晶体液、胶体液量等。结果 A组在休克治疗观察后期血压、pH、BE、HCO3-、O2ER等明显与其他两组有统计学差异（P＜0.05），B组与C组同时间点各组监测指标无统计学差异（P＞0.05）。输血量C组最多，与其他两组比较有统计学差异（P＜0.05），A、B两组输胶体液、晶体液量明显多于C组（P＜0.05），各组失血量无明显统计学差异。结论 ScvO2用于失血性休克兔复苏监测可能比血红蛋白值更敏感和精确，能达到同样的休克复苏效果，并且能减少输血，节约血资源。 [关键词] 中心静脉血氧饱和度；血红蛋白；失血性休克；输血指标 [中图分类号] R541.6+4 [文献标识码] B [文章编号] 1673-9701（2011）36-17-03 An Eeperiment Study Central Venous Oxygen Saturation for Monitoring Blood Transfusion in Hemorrhagic Shock SHENG Xiaosheng1 LIN Li1 HE Zhongping2 SHI Da2 ZHANG Hui2 1.Department of Anesthesiology, the People’s Hospital of Jinhua City in Zhejiang Province, Jinhua 321000， China； 2.Animals Laboratory Centers of Jinhua City in Zhejiang Province, Jinhua 321000， China [Abstract] Objective To study central venous oxygen saturation (ScvO2) in controlled hemorrhagic shock rabbits resuscitation process as a transfusion trigger and traditional transfusion trigger of comparison. Methods Selected New Zealand pure line of rabbit 24 only, simple randomly divided into 3 groups, groups A and B for the observation group, groups C as control group with eight in each. A, B, C three groups respectively by ScvO2≤70%, ScvO2≤75%, hemoglobin (Hb)≥8g/dL as transfusion trigger. From femoral artery bloodletting 10 minute inside, make the MAP to about(40±5)mmHg, and maintain the blood pressure 60 minutes, establish controlled hemorrhagic shock rabbits of animal model. And then started to resuscitate, with colloid and crystalloid infusion according to the proportion 1:2 , infusion rate of about (10-15)mL/(kg?h), according to the blood pressure and heart rate, and proper adjustment according to the different r