摘要
目的：探讨高渗氯化钠羟乙基淀粉40注射液（以下简称高渗盐复合液．HSH）对急性颅内高压伴失血性休克犬复苏的影响及机制。方法：30条犬随机分为6组．分别为①7.5％Nacl组，⑦林格氏液组，③羟乙基淀粉组④HSH组分4ml/kg、8ml/kg、12ml/kg三个剂量组．每组5只．采用硬膜外球囊注水和动脉放血的方法复制急性颅内高压伴失血性休克模型，各组分别在休克1小时后输入①6ml／kg7.5％Nacl（HS），②3倍失血量林格氏液（RL）③1倍失血量羟乙基淀粉（HES），④4ml kgHSH（HSH4），⑤8ml/kgHSH（HSH8）⑥12ml／kgHSH（HSH12）、观察复苏后颅内压（ICP），平均动脉压（MAP）的变化并检测复苏后30min,1h，2h,4h的血钠（Na＋）和血浆渗透压（OSM）的值。检测脑组织丙二醛（MDA）含量、超氧化物歧化酶（SOD）活力，脑组织标本行病理学检查。结果：1复苏前各组MAP、ICP相似无统计学差异（P〉0.05）。2与复苏前相比．复苏后各组均能显著提高MAP（P〈0.01），各组间无统计学差异（P〉0.05）．但HSH组反应速度最快，除Hs组2小时后显著下降外（P〈001）其它各组均能维持4小时。3与复苏前相比．复苏后RL组与HES组的ICP显著上升（P〈0.01），分别在1小时和4小时达到高峰，HS组和HSH组显著降低ICP（P〈0.01），均在1h内下降至最低值．HSH8组，HSH12组和Hs组降低ICP无统计学意义（P〉0.05）．但均比HSH4组明显（P〈O.05）除HSH4组在2小时后回升至复苏前水平．其它各组在4小时后仍接近基础值水平。4复苏后Hs组和HSH组的血Na＋和血浆OSM均明显升高，升高幅度最高为Hs，最低为HSH4。5HSH组脑组织氧自由基含量较其他组明显减少（P〈0.05）。病理学检查显示复苏后4h,HSH组的脑组织损伤较其他缉轻。结论：对于急性颅内高压伴失血性休克的犬模型，HSH能有效纠正休克和降低颅内压，减少氧自由基生成．改善脑水肿。
Objective： To explore the recovery and the mechanism of HSH in acut intracranial hypertension and hemorrhagic shock model of dog. Methods： Thirty dogs randomly divided into six groups of five-animals each,by using the inflation of the subdural ballon with saline and arterial blood withdrawal rapidly, all the dogs were resuscitated with either 6 ml/kg 7.5 % NacI（HS）, Ringer-Latates solution（RL）（three times the amount of blood loss）, hydroxyethyl strarch（HES）（equivalent to the amount of biood loss）,4 ml/kgHSH,8 ml/kgHSH,12 ml/kgHSH after shock for an hour, during the shock and resuscitate period,intractanial pressure,mean arterid pressure and cerebtal perfusion pressure was monitored.and examination of the value of hyponatrema and plasma osmolality, and the level of superoxide dismutase （SOD） and malondialdehyde （MDA） in brain tissue were examined. Specimens of brain tissue were prepared for pathological examination. Result ： 1 .There were no satistically significant in MAP ICP between groups before resuscitation （P〉 0.05）. 2. All groups Can significantly improved MAP after resuscitation （P 〈0.01）. No significant difference among the groups （P〉 0.05）, but HSH group responsed fastestly, excpet HS group decreased significantly after two hours （P 〈0.01） ,the other group is able to maintain four hours. 3.RL group and HES group increased ICP significantly after resuicitation （P 〈0.01）,and arrived to the peak speparatly at one hour and four hours; HS group and HSH group decreased ICP significantly （P 〈0.01）,fallen to the lowest in one hour ;there were no satistically significant among HS group HSH8 group and HSH12 group（P〉0.05）,but they decreased ICP obviously than HSH4 group（p〈0.05）,two hours later, ICP returned to the level of before resuscitation in HSH4 group;other groups maintained nearly to the baseline value after four hours;4, blood sodium and blood osmfality were significantly higher after resuscitation in HSH and HS,The highest rate of increase for the HS, the minimum for HSH4; 5.MDA and SOD levels in Group HSH were evidently lower than other groups at four hours after resuscitation（P〈0.05）. Pathological examination revealed less injury in Group HSH than other groups. Conclusion： In acute intracranial hypertension and hemorrhagic shock model of dog, HSH not only can effectively correct shock and reduce intracranial hypertension ,but also reduce the generation of oxygen free radicals and improve cerebral edema.
出处
《麻醉与监护论坛》
2009年第5期259-263,共5页
Forum of Anesthesia and Monitoring
关键词
脑水肿
失血性休克
高渗氯化钠
羟乙基淀粉
急性颅内高压
intracranial pressure
brain edema
hemorrhagic shock
hypertonic sodium chloride
hydroxyethyl starch
acute intracranial hypertension
