不同晶胶比液体复苏对重症急性胰腺炎比格犬血流动力学的影响

The Effects of Fluid Resuscitation with Different Crystalloid-Colloid Ratio on Hemodynamics in Severe Acute Pancreatitis: An Experimental Study

摘要: 目的：观察不同晶胶比液体复苏对重症急性胰腺炎比格犬血流动力学的影响。方法：取比格犬16条随机分为2组，每组8条犬，分为高晶胶比组和低晶胶比组，分别进行液体复苏，采用自身胆汁逆行主胰管注射法制模。以ITBVI = 850~900 ml/m²作为复苏终点。以晶胶比3:1为界，将实验动物分成低比组(8例)和高比组(8例)，观察造模成功及复苏后即刻(0)、4、8、12、16、20、24、28、32 h犬血流动力学参数变化。采用脉搏指示连续心排血量(PiCC0)热稀释法测定血管外肺水指数(EVLWI)、氧合指数(PaO2：FiO2)、膀胱内压(IAP)的变化。结果：1) 早期采用不同晶胶比液体复苏均可改善SAP比格犬血流动力学指标。2) 复苏后32 h高晶胶比组总液体量(2142 ± 197 ml)、晶体液量(1212 ± 173 ml)及晶/胶比值(4.26 ± 0.83)均明显高于低晶胶比组[分别为(1974 ± 253) ml、(853 ± 135) ml、2.53 ± 0.25，P < 0.05或P < 0.01]。3) 与低晶胶比组比较，高晶胶比组复苏后12 h和24 h的PaO2/FiO2明显下降(12 h: 176.19 ± 1.99比193.65 ± 1.18; 24 h: 187.8 ± 1.06比244.1 ± 1.14)，EVLWI、IAP均明显升高。4) Pearson相关分析显示：EVLWI与PaO2/FiO2呈显著负相关，与IAP呈显著正相关。结论：对重症胰腺炎早期应以EVLWI、IAP为目标行液体复苏，液体复苏中应当提高晶胶比。

Abstract: Objective: To investigate the effects of fluid resuscitation with different crystalloid-colloid ratio on hemodynamics in beagle dogs with severe acute pancreatitis. Methods: 16 beagle dogs were ran-domly divided into 2 groups, each group has 8 dogs. Low crystalloid-colloid ratio group (n = 8) and high crystalloid-colloid ratio group (n = 8) were divided according to crystalloid-colloid ratio (3:1) as the borderline and fluid resuscitation was performed respectively. SAP model was made by retrograde pancreatic duct injection with autogenous bile. Intrathoracic blood volume index (ITBVI) 850 - 1000 ml/m² was confirmed as the end point of resuscitation. Hemodynamic parameters, extravascular lung water index (EVLWI), oxygenation index (PaO2/FiO2), bladder pressure (IAP) were observed at the time point of before fluid resuscitation, and 4, 8, 12, 16, 20, 24, 28, 32 hours after resuscitation. EVLWl was measured with thermal dilution pulse index continuous cardiac output (PiCCO). Result: 1) Hemodynamic parameters can be improved at early fluid resuscitation stage in both groups. 2) The total amount of fluid (2142 ± 197 ml), amount of crystalloid fluid (1212 ± 173) ml and crystalloid-co1loid ratio (4.26 ± 0.83) of the high crystalloid-colloid ratio group was significantly higher than that of the low crystalloid-colloid ratio group [(1974 ± 253) ml, (853 ± 135) ml, 2.53 ± 0.25, P < 0.05 or P < 0.01] at the time point of 32 hours after resuscitation. 3) Compared with low crystalloid-colloid ratio group, PaO2/FiO2 (mm Hg, 1 mm Hg = 0.133 kPa) in high crystalloid-colloid ratio group was lowered significantly at 12 hours and 24 hours after resuscitation (12 h: 176.19 ± 1.99 vs 193.65 ± 1.18, 24 h: 187.8 ± 1.06 vs 244.1 ± 1.14); but EVLWI, ICP were increased significantly. 4) The Pearson correlation analysis showed that: EVLWl with PaO2/FiO2 was correlated negatively, but with the ICP showed positive correlation. Conclusion: In order to guide early fluid resuscitation EVLW, ICP should be monitored and an increasing colloid ratio should be adopted for SAP patients.