不同液体复苏对颅脑外伤并发急性失血性休克大鼠脑保护作用比较  

Effects of Fluid Resuscitation on Cerebral Protection in A Rat Model of Traumatic Head Injury Complicated with Hemorrhagic Shock

作　　者：梅弘勋[1] 张绍东[2] 王恩真[1] 万虹[2] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京市100050 [2]北京市神经外科研究所,北京市100050

出　　处：《中国康复理论与实践》2006年第5期396-398,共3页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的比较不同种类液体复苏对大鼠颅脑外伤并发急性失血性休克模型的局部脑血流(rCBF)、脑水肿和血脑屏障(BBB)的影响。方法SD大鼠60只随机分为5组:①假手术组(Ⅰ组);②脑外伤+休克组(Ⅱ组);③生理盐水组(Ⅲ组);④10%羟乙基淀粉(HES)组(Ⅳ组);⑤小容量高晶体高胶体渗透压混合液(HHS,7.5%NaCl与10%HES按1∶1混合)(Ⅴ组)。记录外伤、休克和复苏前后平均动脉压(MAP)和rCBF的变化,测定复苏后3h脑组织含水量以及脑组织伊文思蓝(EB)含量。结果在复苏后即刻,Ⅲ、Ⅳ、Ⅴ组MAP和rCBF均恢复正常,分别在15min、30min和45min后开始下降,至120min时,Ⅴ组显著高于Ⅲ、Ⅳ组(P<0.05)。复苏后3h,Ⅴ组脑组织含水量双侧正常,Ⅲ组双侧均显著高于Ⅰ、Ⅴ组(P<0.05);Ⅱ、Ⅲ组损伤侧脑组织EB含量显著高于Ⅳ、Ⅴ组(P<0.05)。结论小容量HHS复苏能够有效、持久地恢复颅脑外伤并发失血性休克大鼠的MAP和rCBF,减轻脑水肿,改善BBB。NS恢复MAP和rCBF的时间较短,加重脑水肿和BBB破坏。10%HES的作用介于小容量HHS和NS之间。Objective To compare the effects of normal saline （NS）, 10% hydroxyethyl starch （HES） and hypertonic-hyperoncotic solution （HHS, 7.5% NaCl/10% HES） on regional cerebral blood flow （rCBF）, brain edema and blood brain barrier （BBB） in a rat model of traumatic head injury （THI） complicate with hemorrhagic shock. Methods 60 SD rats were randomized into 5 groups; sham group （n=12）, model group （n=12）, NS group （n=12）, HES group （n=12） and HHS group （n=12）. rCBF and mean arterial pressure （MAP） were determined before and after THI, hemorrhagic shock and resuscitation. Cerebral water content and Evans Blue （EB） content were assessed 3 h after resuscitation. Results MAP and rCBF were restored to baseline values immediately after resuscitation in all resuscitated group and began to decrease 15 min, 30 min or 45 min later, respectively （P 〈 0.05）. 3 h after resuscitation, the brain water content was higher in NS group than those in sham or HHS group （P 〈 0.05）. EB contents of injured hemispheres were higher in model and NS group than those in HES or HHS group （P 〈 0.05）. Conclusion Small-volume resuscitation with HHS can restore MAP and rCBF, decrease brain edema and improve BBB in a rat model of THI complicate with hemorrhagic shock.

关 键 词：脑外伤 失血性休克 复苏 脑水肿 脑血流 血脑屏障 大鼠 

分 类 号：R651.1[医药卫生—外科学]