高渗氯化钠羟乙基淀粉复合液对失血性休克肺的保护作用  

Hypertonic saline plus hydroxyethyl starch alleviates lung injury in rats with hemorrhagic shock

作　　者：刘昱升[1] 邱晓东[2] 景亮[2] 

机构地区：[1]南京市妇幼保健院麻醉科,210004 [2]东南大学附属中大医院麻醉科

出　　处：《临床麻醉学杂志》2007年第10期842-844,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察用高渗氯化钠羟乙基淀粉复合液(7.5%氯化钠+6%羟乙基淀粉200/0.5,HHS)小容量复苏对失血性休克后肺损伤的影响。方法雄性SD大鼠随机分为五组:正常对照组(CON组,n=6):不放血不补液;其他大鼠通过放血使MAP降至45mmHg并维持120min,然后分为:休克组(SH组,n=6),不补液复苏;HHS组(n=8),用HHS5ml/kg静脉滴注;7.5%氯化钠高渗溶液组(HTS组,n=6),用7.5%NaCl5ml/kg静脉滴注;复方乳酸钠组(LR组,n=7),用3倍失血量的复方乳酸钠静脉滴注。观察休克2h末、补液结束即刻、15、30、60、120、180min时MAP、CVP的变化,测定补液结束2、24h存活动物的氧合指数和肺水含量、肺髓过氧化物酶(MPO)水平、肺损伤评分。结果在补液结束120、180min,HTS组MAP、CVP低于HHS和LR组(P<0.05);在补液结束24h,HHS组氧合指数、肺水含量、肺MPO水平、肺损伤评分优于HTS和LR组(P<0.05)。结论用HHS小容量复苏失血性休克,维持血流动力学稳定时间更长;对肺组织的保护作用优于7.5%氯化钠高渗溶液或复方乳酸钠。Objective To investigate the effect of the low volume resuscitation with hypertonic saline combined with hydroxyethyl starch （200/0.5） solution （HHS） on lung injury in rats with hemorrhagic shock. Methods Thirty three male SD rats were randomly divided into five groups. The rats in sham shock（CON,n=6） group（had no bleeding and infusion）. The rats of others experienced hemorrhagic shock by. withdrawing blood to MAP of 45 mmHg for 120 min, then were divided into shock group （SH group, n= 6, with no infusion）, H HS group （n = 8, infusion with 5 ml/kg H HS iv）, hypertonic saline（HTS） group （n = 6, infusion with 5 ml/kg 7.5 % NaCl iv）, and lactate Ringer＇s solution group（LR group, n= 7, transfusion with three times of the volume of withdrawn blood）. MAP and CVP were recorded at the 2 h after end of hemorrhagic shock, and 15,30,60,120,180 min after infusion. Oxygenation indexes （PaO2/FiO2） at 2 and 24 h, lung water content, pulmonary myeloperoxidase（MPO） level, and lung damage scores of survival rats at 24 h were assessed respectively after infusion. Results MAP and CVP of HTS group were significantly lower than those of HHS and LR groups at 120,180 min after infusion（P〈0. 05）. PaO2/FiO2, lung water content, pulmonary MPO level,and lung damage scores in HHS group were all better significantly than those in HTS and LR groups at 24 h after infusion （P 〈 0. 05）. Conclusion The use of HHS for resuscitation of hemorrhagic shock is better than HTS or LR in maintaining stable hemodynamics and alleviating lung injury induced by hemorrhagic shock after resuscitation.

关 键 词：失血性休克 肺损伤 羟乙基淀粉 高渗氯化钠 

分 类 号：R96[医药卫生—药理学]