臺灣博碩士論文加值系統

在許多的失血性休克動物實驗中，常需使用到麻醉劑，由於麻醉劑會干擾到實驗動物之生理表現，因此無法模擬臨床病人之情境。在非控制性失血休克模式則必須考慮如何控制失血的量與速度，若保持實驗動物清醒狀態時，則必須考慮如何約束實驗動物。目前大多數的失血性休克動物模式，無法長時間連續監測實驗動物之生理參數超過24小時。
本研究主要在建立一能反應臨床病患實際病況，且能連續監測失血後24小時以上生理指標變化之動物實驗模式，以探討失血後之生理病理變化，作為醫護人員對失血性休克病人病情進展與採行相關醫護處置時之參考依據，協助護理人員掌握病患病情變化。
實驗設計主要策略為：(一)實驗過程中動物不麻醉全程保持清醒；(二)實驗動物仍能上下左右活動，採用尾部約束；(三)使用固定血量失血；(四)採用連續24小時持續慢性失血。實驗動物共分成三組，以股動脈插管之方式進行失血，在初次失血時第一組失血量為全血之40 ﹪、第二組失血30 ﹪、第三組失血0 ﹪。
實驗結果顯示，本模式失血40 ﹪與30 ﹪組之兩天存活率皆為87.5﹪，本模式可觀察累積失血量與Hct之變化來判斷失血達到 50 ﹪之時間點，同時Lactic acid於失血 40 ﹪組因代償失調，由第9小時開始升高，於第18小時達到3倍，比失血30 ﹪組較高。
失血性休克促使TNF-α �n與 IL1-β 的分泌，使neutrophil 黏附到內皮細胞上，在系統性發炎上扮演一重要的角色。本研究失血40 ﹪組WBC 於失血後第1到6小時逐漸減少，TNF-α �n與 IL1-β 於失血後第1到 9 小時逐漸增高，可明顯看出失血與發炎反應之關係。
於失血第6小時後血清AST、ALT、BUN、LDH 和 CK-MB值逐漸升高，反應出肝臟、腎臟與心臟之早期損傷，於失血48小時後，由組織病理切片進一步可看出肝臟、腎臟、心臟、肺臟與小腸在失血後組織層次均出現損傷，未來將以初次失血量40 ﹪之方式作為後續相關研究之基準，亦可利用本模式，進一步作SIRS 與 MODS 之相關研究。同時護理人員於休克早期能經由觀察Hct、Lactic acid與血清生化值之變化，了解病患失血與器官損傷之程度，有效掌握病情變化。

Animal models utilizing anesthesia have been used in a number of studies of hemorrhagic shock. The anesthetic drugs may interfere with the physiologic course of hemorrhagic shock and make the animal impossible to simulate the clinical situations. On the other hand, in previous uncontrolled hemorrhagic shock animal models, the rate and the volume of blood loss couldn’t be adequately controlled. So that the animal models would prolonged anesthetic or a fasting state. In addition, these models can not measure physiologic parameters continuously at given intervals for a prolonged period.
The experiments were designed to establish an animal model based on the clinical situation to study hemorrhagic shock. Hemorrhagic shock was induced by withdrawing blood from a femoral arterial catheter. The blood volume withdrawn was 40 ﹪of the total blood volume for group 1 and 30 ﹪for group 2 and 0 ﹪for group 3 at the first blood withdrawal.
The data showed that the survival rate was 87.5% at the 48 h in both blood withdrawal groups. In which the experiment extends the blood withdrawal from the femoral artery catheter length of time to 48 hous. Moreover, without anesthesia and restraint the animals, conscious and perceived no pain, did not struggle when their blood was withdrawn.
In our model, we can observe the cumulative volume of blood withdrawal and Hct concentration to decide when blood loss reached to 50 ﹪.Meanwhile, cumulative hemorrhage resulted in an twofold increase of plasma lactic acid at 9 h and threefold increase at 18 h in group 1, whose increase was higher and earlier than group 2. This could be caused by decompensation.
TNF-α �nand IL1-βplay a major role in systemic inflammatory response. They also enhance leukocyte-endothelial cell adhesion, stimulate chemokine secretion, and induce neutrophil activation. In the present study, the number of WBC decreases within the first 6 hours of blood withdrawal, and the TNF-α �nand IL-1βincrease �nwithin the first 9 hours of blood withdrawal in group 1, which suggests a stronger inflammatory response after hemorrhage.
After hemorrhage, the blood AST、ALT、BUN、LDH and CK-MB concentrations significantly increased in starting the 6 h in group 1 and the pathological HE stain also shows the lesion on liver、kidney、heart and lung. The results suggest that hemorrhagic shock model is associated with multiple organ dysfunctions and may be useful for the study of SIRS and MODS.
Nurse practitioners can benefit from the observation of the changes of Hct、lactic acid and biochemistry levels in the early stage of hemorrhagic shock, to understand the extent of blood loss and MODS of the patients, and eventually take quick actions to help the patients.

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縮寫表．．．．．．．．．．．．．．．．．．．．．．．．．．
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第一章 緒論．．．．．．．．．．．．．．．．．．．．．．．．
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一、前言
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二、現有失血性休克動物實驗模式
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三、失血與多重器官損傷
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四、研究目的
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第二章 文獻探討．．．．．．．．．．．．．．．．．．．．．．．
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一、休克之定義．．．．．．．．．．．．．．．．．．．．
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二、低血容性休克之定義．．．．．．．．．．．．．．．．．
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三、失血性休克的分級．．．．．．．．．．．．．．．．．．
10
四、失血性休克的分期．．．．．．．．．．．．．．．．．．
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五、休克時之生理反應．．．．．．．．．．．．．．．．
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第三章 影響動物實驗血液樣本血球生化測量值準確度之因素探討
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一、研究背景．．．．．．．．．．．．．．．．．．．．．
23二、實驗設計．．．．．．．．．．．．．．．．．．．．．
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三、材料與方法．．．．．．．．．．．．．．．．．．．．
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四、統計與分析．．．．．．．．．．．．．．．．．．．．
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五、結果與討論．．．．．．．．．．．．．．．．．．．．
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六、結論．．．．．．．．．．．．．．．．．．．．．．．
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第四章 建立清醒鼠固定血量持續失血休克模式．．．．．．．．．
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一、研究背景．．．．．．．．．．．．．．．．．．．．．．
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二、實驗設計．．．．．．．．．．．．．．．．．．．．．．
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三、材料與方法．．．．．．．．．．．．．．．．．．．．．
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四、統計與分析．．．．．．．．．．．．．．．．．．．．．
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五、結果．．．．．．．．．．．．．．．．．．．．．．．．
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六、討論．．．．．．．．．．．．．．．．．．．．．．．．
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七、結論．．．．．．．．．．．．．．．．．．．．．．．．
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第五章 探討固定血量持續失血休克模式對清醒鼠之器官損傷．．．
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一、研究背景．．．．．．．．．．．．．．．．．．．．．
76
二、實驗設計．．．．．．．．．．．．．．．．．．．．．
79
三、材料與方法．．．．．．．．．．．．．．．．．．．．
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四、統計與分析．．．．．．．．．．．．．．．．．．．．
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五、結果．．．．．．．．．．．．．．．．．．．．．．．
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六、討論．．．．．．．．．．．．．．．．．．．．．．．
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七、結論．．．．．．．．．．．．．．．．．．．．．．．
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第六章 總結論．．．．．．．．．．．．．．．．．．．．．．．
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參考文獻．．．．．．．．．．．．．．．．．．．．．．．．．．
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已發表之論文相關著作
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