高晶体-高胶体渗透压混合液对心肺复苏后大鼠脑水肿影响的研究  

Effect of Hypertonic-hyperoncotic Solution on Brain Edema Formation after Asphyxial Cardiac Arrest in Rats

作　　者：许淼[1] 袁世荧[1] 姚尚龙[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,武汉430022

出　　处：《华中科技大学学报（医学版）》2005年第1期111-114,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：*湖北省科技攻关计划资助项目 (No. 2004AA301C12)

摘　　要：　目的　研究高晶体 高胶体渗透压混合液对心肺复苏后大鼠脑水肿的影响。方法　36 只大鼠随机分为假手术组、生理盐水组及高晶体 高胶体渗透压混合液组3 组。采用窒息致心跳骤停法制作大鼠心肺复苏模型, 于自主循环恢复后分别静脉注射生理盐水、高晶体 高胶体渗透压混合液。自主循环恢复后 2 h大鼠断头取脑, 采用干 湿重法检测3组脑组织含水量的变化; 采用伊文思蓝荧光法检测3组血脑屏障 (BBB) 通透性的变化; 采用免疫组化法检测细胞间黏附分子 1 (ICAM 1) 在脑血管内皮细胞上表达的变化; 采用髓过氧化物酶 (MPO法 ) 检测脑组织中性粒细胞数目的变化。结果　在复苏后2 h时, 生理盐水组和高晶体 高胶体渗透压混合液组脑组织含水量、脑组织伊文思蓝含量、ICAM 1表达及中性粒细胞的变化较假手术组明显增加 (均 P<0. 01), 但高晶体 高胶体渗透压混合液组明显低于生理盐水组 (P<0. 01或P<0 .05)。结论　窒息致心跳骤停, 心肺复苏后大量中性粒细胞活化, 脑血管内皮细胞 ICAM 1表达增加, 它们的相互作用导致BBB损伤, 促使血管性脑水肿形成。复苏后即刻给予高晶体 高胶体渗透压混合液可减少中性粒细胞聚集, 降低 ICAM 1表达, 使BBB的损伤减轻, 从而减轻了心肺复苏后脑水肿的程度。Objective To investigate the effect of hypertonic-hyperoncotic solution (HHS) on brain edema formation after asphyxial cardiac arrest in rats. Methods Thirty-six rats were randomly divided into three groups: sham operation group, normal saline group and HHS group. Asphyxial cardiac arrest animal model was made and upon return of spontaneous circulation (ROSC) the rats randomly received either NS or HHS. At second hour after ROSC, the rats were decapitated and brain tissue collected. Brain water content was determined by brain wet-to-dry weight ratio. Content change of Evan’s blue (EB) in brain was quantitatively determined by fluorescence spectrophotometer to evaluate the change of blood-brain barrier (BBB). The ICAM-1 expression in brain vascular endothelium was assessed by using immunohistochemical technique and brain neutrophil content was determined by myeloperoxidase (MPO) activity. Results At second h after ROSC, brain water content, EB content, ICAM-1 expression level and MPO activity were significantly increased in normal saline group and HHS group as compared with those in sham operation group (P<0.01), but they were obviously decreased in HHS group as compared with those in normal saline group (P<0.01, or P<0.05). Conclusion Most PMN were activated and the expression of ICAM-1 was increased significantly after asphyxial cardiac arrest in brain, which results in the injury of BBB and the formation of vasogenic brain edema. HHS can decrease the aggregation of PMN, inhibit the expression of ICAM-1, decrease the permeability of BBB, so attenuate the severity of brain edema.

关 键 词：高晶体-高胶体渗透压混合液 心肺复苏 大鼠 脑水肿 ICAM-1 生理盐水 BBB 表达 数目 变化 

分 类 号：R743[医药卫生—神经病学与精神病学] R605.971[医药卫生—临床医学]