大鼠急性脊髓损伤后不同复苏液体治疗的比较  

Comparison of different fluid therapies following acute spinal cord injury in rats

作　　者：徐振东[1] 石学银[1] 何星颖[1] 刘刚[1] 

机构地区：[1]第二军医大学长征医院麻醉科,上海200003

出　　处：《第二军医大学学报》2005年第2期170-173,共4页Academic Journal of Second Military Medical University

基　　金：全军医药科研"十五"规划课题面上课题(03M004);上海市卫生局科技发展基金(024097)

摘　　要：目的:研究大鼠急性高位脊髓损伤后,不同复苏液体治疗对左心室功能及伤段脊髓血脊屏障和含水量的影响。方法:将C7脊髓损伤15 min后的大鼠随机分为4 组(n=8):不补液的对照组、7.5%高渗盐水治疗组(HS组)、6%羟乙基淀粉组(HES组)和平衡液组(BS组)。补液各组于4 min内均予4 ml/kg的相应液体,继以10 ml·kg-1·h-1持续输注,观察记录5、15、30 min时血流动力学的变化。30 min时注射0.5%伊文思蓝(EB)1 ml,2 h后取伤段脊髓,测含水量和EB含量。结果:C7损伤后,各组的心率(HR)在不同时点无明显区别。平均动脉压(MAP)、左室收缩压(LVSP)、左室内压力变化最大速率(±dp/dtmax)比较显示,补液5 min时,HS组显著高于对照组(P<0.05);15、30 min时HS组和HES组的都显著高于对照组(P<0.05);而BS组在不同时点都与对照组无显著差异。HS和HES组的脊髓组织含水量与EB含量均低于对照组,BS组含水量高于对照组(P<0.05)。结论:高位脊髓损伤后早期以高渗盐水和6%羟乙基淀粉复苏,可以改善左心功能,一定程度上都可减轻伤段脊髓的水肿。平衡液对心功能没有改善作用,却可加重脊髓的水肿。Objective:To assess the effects of different fluid therapies on myocardial function,blood-spinal cord barrier and water content of spinal cord after acute high level spinal cord injury(SCI) in rats.Methods: Thirty-two male SD rats, weighing (300±20) g, were anesthetized intraperitoneally with pentobarbital (40 mg/kg). A cervical laminectomy extending from C6-T1 was performed and the experimental acute cervical 7 spinal cord injury model was created by modified Allen’s method,and then the rats were randomly divided into 4 groups(n=8): control group(C group) with no fluid resuscitation, 7.5% hypertonic saline group(HS group), 6% hydroxyethyl starch group(HES group) and banlanced solution group (BS group).Fifteen minutes after injury, rats of each treatment groups were given (iv. at 4 ml/kg) above-mentioned fluids in 4 min,then continuously infused at a rate of 10 ml·kg -1 ·h -1 over for 30 min.MAP,HR,left ventricular systolic pressure (LVSP),and ±dp/dt max were recorded at 5,15 and 30 min.At 30 min, 0.5% Evan's blue(EB) 1 ml was injected iv.Two hours later the animals were sacrificed and the injured segments of spinal cords were removed for determination of water content and EB content.Results:After SCI there were no differences of HR at different time points in each group. At 5 min,HS significantly increased MAP,LVSP and ±dp/dt max compared with control group(P<0.05).At 15 and 30 min,these variables of both HS group and HES group were much higher than those of control group(P<0.05),while these of BS group had no significant changes.Compared with control group, spinal cord water and EB content were significantly lower in HS group and HES group,but water content in BS group were markedly higher (P<0.05).Conclusion: Hypertonic saline and hydroxyethyl starch used for early resusciation of acute high level spinal cord injury can improve myocardial function and attenuate spinal cord edema. Banlanced solution can aggravate issue edema instead of improving hemodynamics.

关 键 词：脊髓损伤 液体疗法 心脏功能试验 毛细血管通透性 

分 类 号：R651.2[医药卫生—外科学]