高容量血液滤过治疗犬创伤性脑水肿  

Effect of high volume hemofiltration on traumatic cerebral edema in canine

作　　者：黄东健[1] 徐如祥[1] 瞿文军[1] 

机构地区：[1]南方医科大学(原第一军医大学)附属珠江医院神经外科

出　　处：《中华创伤杂志》2005年第7期508-511,共4页Chinese Journal of Trauma

基　　金：广东省医学科研立项资助课题(A2002589)

摘　　要：目的探讨高容量血液滤过(HVHF)对创伤性脑水肿的治疗机制。方法18只健康犬随机分为3组,采用Feeney自由落体法致犬脑损伤,伤后6h每组给予不同的处理。血液滤过组:行HVHF,血流量为100ml/min,置换液输入速度为1000～1500ml/h;常规降温组:行冰敷降温;对照组:林格氏液1～3ml/min维持出入量平衡。观察治疗过程中生命体征、颅内压和外周血的乳酸、细胞因子水平的变化,以及脑组织含水量和病理改变。结果行HVHF后,犬肛温可在15～18min后下降并维持29～32℃之间,与常规降温组和对照组比较,行HVHF后外周血乳酸、细胞因子峰值浓度、颅内压均明显下降(P<0.05)、脑组织含水量减少(P<0.01)。结论HVHF降温效果好,使用安全,可成为亚低温治疗的一个方法。HVHF通过对流和置换液的交换调节内环境,清除细胞因子等炎性介质降低了炎性反应的程度,对脑损伤后脑保护有利。Objective To investigate the therapeutic mechanism of high volume hemofiltration (HVHF) in treatment of traumatic cerebral edema. Methods Eighteen healthy hybrid canines (either sex) were randomly divided into three groups: hemofiltration group, routine hypothermia group and control group. Animal head injury model was made by Feeney's method. Six hours after the brain injury, hemofiltration group received HVHF, when blood flow was 100 ml/min and replacement fluid infusion speed 1 000-1 500 ml/h;routine hypothermia group descended the temperature by ice; control group was injected with Ringer's solution at speed of 1-3 ml/min so as to maintain the income and outcome balance. Vital signs including intracerebral pressure, lactic acid and cytokine in plasma were monitored during the treatment. The brain water content and pathologic changes were also observed after sacrifice of the canines. Results The anal temperature decreased to and maintained at 29-32 ℃ 15-18 minutes after HVHF. Compared with routine hypothermia group and control group, hemofiltration could significantly decrease plasma lactic acid, peak concentration of cytokine, ICP and the water content in brain tissues (P<0.01). Conclusions HVHF is a safe technique of mile hypothermia on treatment of severe cerebral edema. Meanwhile, HVHF is beneficial to protection of brain after brain injury for it can inhibit the inflammation by removing cytokines and regulate internal environment via convection and replacement fluid exchange.

关 键 词：创伤性脑水肿 血液滤过治疗 脑组织含水量 高容量血液滤过 HVHF 细胞因子水平 亚低温治疗 治疗机制 自由落体 冰敷降温 林格氏液 生命体征 治疗过程 病理改变 降温效果 炎性反应 炎性介质 脑损伤后 min 置换液 对照组 颅内压 

分 类 号：R651[医药卫生—外科学]