摘要
目的探讨脉压变异(PPV)对失血性休克家猪血容量状态评价的准确性并与每搏输出量变异(SVV)比较。方法将10只健康家猪充分镇静肌松,给予机械通气,通过正常血容量、失血量10%、20%、30%和40%5个阶段建立失血性休克家猪模型,每个阶段5min内完成释放相应血容量,稳定10min后采用脉搏指示连续心排血量(PiCCO)监测HR、MAP、CVP、心脏指数(CI)、每搏量指数(SVI)、外周血管阻力指数(SVRI)、胸腔内血容量指数(ITBVI)、SVV和PPV等血流动力学指标的变化。结果与正常血容量比较,失血量20%、30%、40%的家猪HR明显增快(P<0.05),失血量30%、40%的家猪MAP、CVP明显降低(P<0.05),失血量10%、20%、30%和40%的家猪SVI明显降低,而SVV和PVV明显升高(P<0.05),失血量30%、40%的家猪CI,失血量20%、30%和40%的家猪ITBVI明显降低(P<0.05)。SVV和PPV与失血量相关系数分别为0.699和0.764(P<0.05),SVV和PPV与CI变化值(ΔCI,各失血阶段与正常血容量的差值)的相关性均较好,相关系数分别为0.795和0.736(P<0.05)。ITBVI的变化值(ΔITBVI)、CVP变化值(ΔCVP)与CI相关系数分别为0.734和0.499(P<0.05),相关系数明显小于SVV和PPV。ITBVI、CVP与失血量相关系数分别为0.895、0.768(P<0.05)。结论 PPV和SVV均可以准确反映失血性休克时的血容量状态,并且在休克早期即出现明显变化。
Objective To evaluate the validity of pulse pressure variation（PPV） for predicting volume state in hemorrhagic shock pigs by comparing with stroke volume variation （SW）. Methods Ten healthy pigs were anesthetized after tracheal intubation and ventilated. Then the pigs were bled from 10% up to 40% of their blood volume by increments of 10% （normal volume, 10%, 20%,30%0 and 40% stage）, within 5 rain between each stage. Hemodynamic measurements heart rate （HR）, mean arterial blood pressure （MAP）, systemic vascular resistance index （SVRI）, cardiac index （CI）, stroke volume index （SVI）, intrathoratic blood volume（ITBVI）. PPV and SW were obtained 10 minutes after stabilization. Results PPV and SW increased significantly in early period （blood loss of 10%） in hemorrhagic shock（P〈0. 05）, while SVI decreased on the 10% stage（P〈0. 05）. CI and ITBVI decreased gradually when the blood loss achieved 20% （P〈0. 05）, with HR increased（P〈0.05）. CVP and MAP decreased after the blood loss achieved 30%（P〈0. 05）. PPV and SW showed significant positive correlation with blood loss volume （r= 0. 699, r=0. 764, P〈0.05） ,moreover APPV and ASW also showed positive correlation to CI （r=0. 795, r=0. 764, P〈 0.05）, which were prior to CVP （r=0. 499）. Conclusion PPV and SW could predict volume change in early period of hemorrhagic shock.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第5期495-497,共3页
Journal of Clinical Anesthesiology
基金
南京市卫生局重点项目(ZKX0417)
关键词
失血性休克
容量
每搏输出量变异
脉压变异
Hemorrhagic shock
Volume
Stroke volume variation Pulse pressure variation
