不同补液方式在创伤合并失血性休克早期急救中的临床应用

目的：研究不同补液方式在创伤合并失血性休克早期急救中的临床应用。方法：选取2013 年6 月到2015 年6 月我院收治的创伤合并失血性休克患者130 例,按照随机数字表法将患者分为I组和II组,每组65 例,I组给予限制性液体补充,II 组给予充足液体补充,比较两组输液量、输血量、平均动脉压、心率、死亡率以及并发症。结果：I 组输液量、输血量、心率以及平均动脉压均显著低于II 组,比较差异具有统计学意义（P＜0.05）;I 组死亡率为18.5％（12/65）显著低于II组的38.5％（25/65）,比较差异具有统计学意义（P＜0.05）;I 组并发症发生率为16.9％（11/65）显著低于II组的36.9％（24/65）,比较差异具有统计学意义（P＜0.05）。结论：限制性液体补液应用于创伤合并失血性休克早期急救效果较好,具有较低的死亡率和并发症发生率。     

腹腔复苏治疗创伤失血性休克大鼠的实验研究

目的:探讨在静脉输液通道无法建立的情况下,单纯腹腔复苏对创伤失血性休克是否有效.方法:40只SD大鼠被随机分为A组(空白对照组)、B组(休克不复苏组,出血+急救期不接受任何治疗)、C组(腹腔复苏组,出血+急救期给予腹腔注射平衡液10ml/100g体重)、D组(静脉输液组,出血+急救期静脉输入平衡液并保持大鼠MAP在60+5mmHg),B、C、D三组大鼠均制备为未控制创伤失血性休克模型,记录各组大鼠的生存时间,比较各组大鼠的生存率,在0、30、90和120 min时相点观察比较各组大鼠临床指标、血气分析指标和血清TNF-α.结果:C组大鼠的存活时间较B组明显延长(P＜0.05);C组大鼠72 h存活率明显高于B组,但低于D组(P＜0.05).C组大鼠的临床复苏指标、血气分析指标均优于B组,但较D组差;C组大鼠血清TNF-α低于B组,高于D组.C组大鼠生存率明显高于B组,低于D组.结论:腹腔复苏治疗创伤失血性休克大鼠是有效的但效果比静脉复苏差.     

Methods and Errors in Measurements of Synovial Fluid Volume in Stifles with Low Volume and High Viscosity Synovial Fluid. An Experimental Study in Goats

Synovial fluid (SF) volume was calculated using various methods in the stifles of goats, in which the cranial cruciate ligament had been transected on one side. Measurements were performed prior to surgery and again 4,8, and 18 weeks following surgery, by measuring the dilution of an injected radioactive tracer diluted by the SF. Later, 7 months following surgery, SF volume measurements using simple arthrocentesis were performed on stifles in 9 of the goats, and the SF that could not be aspirated, was calculated using 2 indirect methods simultaneously on identical fluids in 3 of these goats. SF was also collected directly during staged arthrotomy of the stifles in 4 goats. There were conflicting results between methods, but the resulting calculated SF volumes seemed to be larger in the operated stifles compared to the controls for all the methods at about the same degree. The 2 indirect methods used to calculate the fluid remaining in the joints following arthrocentesis gave disparate volume calculations. The experiments revealed sources of error in all methods. Direct methods failed to acquire the total fluid volume, and indirect methods were subject to improper mixing and escape of the injected fluid or synovial fluid or both. It was concluded that none of the methods could be used to measure the “true” volume of SF, if such a concept exists and can be defined. None of the methods were considered reliable to compare volumes in different type of joints containing this type of fluid. It was, however, concluded that all the methods gave indication of increased SF volume present on a relative basis when paired joints were compared.     

聚乙二醇化重组人白细胞介素-6经不同途径给药的药代动力学比较研究

目的 研究聚乙二醇化重组人白细胞介素-6不同给药途径的药代动力学.方法 将大鼠分为皮下给药组、静脉给药组,每组各设3个剂量组.分别按40μg/kg、20μg/kg、3μg/kg给药.同位素示踪法用碘标记PEGrhIL-6,采用TCA沉淀法检测放射性浓度,3P87软件判断房室模型并计算各种参数,并检测125I-PEG-rhIL-6皮下注射大鼠后不同时间的血药浓度.结果 ①静脉给药大鼠体内的血药浓度-时间曲线符合二房室模型,而皮下给药大鼠体内的血药浓度-时间曲线符合一房室模型;②皮下给药的达峰时间比静脉给药慢,但其有效血药浓度维持时间较静脉给药长;③皮下给药较静脉给药各时点血药浓度低.结论 皮下给药毒性低,是一种安全可靠的给药方法;同时有效血药浓度维持时间较长,有利于治疗血小板减少症.     

Intraruminal Fluid Administration to Goats: Effects of Handling and Fluid Temperature

Physiological stress response to intraruminal fluid administration was studied in 5 female goats. The fluid was given through a stomach tube. The water was cold (10°C) or warm (38°C) and in an amount of 7.5-10% of body weight. Plasma concentrations of adrenaline, noradrenaline and Cortisol increased significantly after both treatments. Adrenaline and noradrenaline responses were greater and more longlasting after cold water administration, but there was no difference in Cortisol response between cold and warm water. Haematocrit and plasma protein concentrations increased also and the effects of cold water lasted longer. Blood pressure showed a sharp rise of short duration and was independent of water temperature. The immediate tachycardie response was similar with both treatments, but cold water caused an additional peak 15 min later. The cooling did not increase plasma histamine level. The results suggest that stomach intubation and administration of water into the rumen leads to strong activation of hormonal and cardiovascular stress parameters even in goats well adapted to handling. Low temperature of the fluid further heightens the effect. Warming of fluids to near body temperature before their administration is thus recommended.