7.5％高渗氯化钠对血浆游离血红蛋白浓度的影响  

Effects of 7.5% hypertonic NaCI on erythrocytes in rabbit with or without severe hemorrhagic shock

作　　者：卢家凯[1] 刘怀琼[2] 潘贤佖[1] 汪志文[3] 

机构地区：[1]北京军区总医院麻醉科,北京市100700 [2]第三军医大学大坪医院麻醉科 [3]第三军医大学野战外科研究所中心室

出　　处：《中华麻醉学杂志》1996年第1期9-12,共4页Chinese Journal of Anesthesiology

摘　　要：选用家兔46只,随机分为四组:(1) 正常容量输注4ml/kgHS组(n=11);(2) 失血性休克输注4ml/kg生理盐水(NS)组(n=2);(3) 休克后输注4ml/kg高渗氯化钠(HS)组(n=18);(4) 休克后输注10ml/kgHS组(n=5)。测定了前三组动物的平均动脉压(MAP)、红细胞(RBC)变形指数(DI)、RBCS0%溶血点、膜上Na^+-K^+-ATP酶活力及所有各组的血浆游离血红蛋白浓度(FHB)和RBC平均体积(MCV)。结果显示,血容量正常时HS对血浆FHB无明显影响;给失血性休克动物输注HS后MAP显著提高,MCV显著缩小,同时FHB显著提高,大剂量组FHB提高更明显,提示RBC破坏增加;失血性休克后出现的DI及膜上Na^+-K^+-ATP酶活力下降和50%溶血点显著右移均无显著改善。认为休克后RBC变形性下降、脆性增加、膜内外渗透平衡调节功能下降,在此基础上应用HS,使MCV在短时间内发生变化,是RBC破坏增加的重要原因。To evaluate the effect of 7.5% hypertonic NaCl(HS) on erythrocytes. 46 adult healthy rabbits were anesthetized with intravenous pentobarbital. Severe hemorrhagic shock(SHS) was induced by slow bleeding from femoral artery, with MAP being reduced to 5.3kPa and being kept at this low level for one hour. The subjects with normovolemia(group Ⅰ, n=11) were infused intravenously with HS 4ml/kg. and the others with SHS were allocated to receiving normal saline 4ml/kg (group Ⅱ, n=12), HS 4ml/kg(group Ⅲ, n=18) or HS 10ml/Kg(group Ⅳ, n=5), respectively. The blood samples were taken, before SHS, immediately following SHS, and 10, 20, 30, 60 and 120 mins after infusion of HS or NS, to measure plasma level of free hemoglobin (FHB), mean corpuscular volume (MCV). Na^+-K^+ ATPase activity of erythrocyte membrane, erythrocyte deformbility index(EDI) and fragility (EF). separately. MAP was recorded during whole procedures. All of values kept stable (P>0.05) except for a transient increase of MCV(P<0.05) with HS in group Ⅰ. Immediately following SHS. MAP. Na^+-K^+ ATPase activity. EF and EDI decreased (P<0.05), in group Ⅱ, Ⅲ and Ⅳ; all values did not alter further with NS in group Ⅱ(P>0.05); with HS 4ml/kg in group Ⅲ, FHB level and MAP were ascended and MCV was reduced (P<0.05), and the others kept constant (P>0.05); with HS 10ml/kg in group Ⅳ, FHB level went up and MCV decreased(P<0.05). As compared correspondingly with values after infusion of NS in group Ⅱ. MAP and FHB level were sent up. MCV was reduced at 10th min in group Ⅲ(P<0.05); FHB level was elevated and MCV was decreased in group Ⅳ(P<0.05). It is sug gested that SHS may reduce the deformability and fragility of erythrocyte and membrane ability to balance osmotic pressure between inside and outside erythrocyte, as well as low-dose HS can decrease MCV, so intravenous HS may result in the increase of hemolysis during resuscitation of SHS.

关 键 词：高渗氯化钠 游离血红蛋白 红细胞脆性 

分 类 号：R605.971[医药卫生—急诊医学]