高渗盐复合液对急性颅内高压伴失血性休克犬的治疗作用  

Effects of hypertonic sodium chloride hydroxyethyl starch 40 injection in treatment of acute intracranial hypertension complicated by hemorrhagic shock in dogs

作　　者：肖华平[1] 古妙宁[1] 肖金仿[1] 徐翔[1] 赵振龙[1] 

机构地区：[1]南方医科大学南方医院麻醉科,广东广州510515

出　　处：《南方医科大学学报》2008年第3期385-388,共4页Journal of Southern Medical University

基　　金：吴孟超医学科技基金(RG-C2007032)~~

摘　　要：目的探讨高渗氯化钠羟乙基淀粉40注射液(HSH)对急性颅内高压伴失血性休克犬的治疗作用及机制。方法20条犬随机分为4组,分别为7.5%氯化钠组(HS组)、林格氏液组(RL组)、羟乙基淀粉组(HES组)和HSH组,每组5只。采用硬膜外球囊注水和动脉放血的方法复制急性颅内高压伴失血性休克模型,各组分别在休克1h后按上述分组顺序输入6ml/kgHS、3倍失血量RL、1倍失血量HES、8ml/kgHSH,观测复苏后颅内压(ICP)、平均动脉压(MAP)、脑灌注压(CPP)的变化,并检测实验前和休克后,复苏后30min、1h、4h的血钠(Na+)和血浆渗透压(OSM)水平。结果(1)复苏前各组MAP、CPP、ICP无统计学差异(P>0.05)。(2)与复苏前相比,复苏后各组均能显著提高MAP(P<0.01),各组间无统计学差异(P>0.05),但HSH组反应速度最快,除HS组2h后显著下降外(P<0.01),其余各组均能维持4h。(3)与复苏前相比,复苏后各组均能显著提高CPP(P<0.01),2h后HS组CPP显著下降(P<0.01),4h后HSH组仍能维持较高CPP。(4)与复苏前相比,复苏后RL组与HES组的ICP显著上升(P<0.01),分别在1h和3h达到高峰,HS组和HSH组ICP显著降低(P<0.01),均在1h内下降至最低值,两组降低ICP无统计学意义(P>0.05),且均能维持4h。(5)复苏后HS组、HSH组血Na+浓度和血浆OSM较复苏前明显升高(P<0.05)。结论对于急性颅内高压伴失血性休克的犬模型,HSH能有效纠正休克和降低颅内压,且维持时间较HS长。Objective To observe the effect ofhypcrtonic sodium chloride hydroxycthyl starch 40 injection （HSH） in treatment of acute intracranial hypertension complicated by hemorrhagic shock in dogs, and explore the mechanism of the effects of HSH. Methods Twenty dogs wcrc randomized into 4 equal groups, namely the 7.5% NaCl（HS） group, Ringcr-Lactatvs solution （RL） group, hydroxycthyl strarch （HES） group, and HSH group. Canine models of acute intracranial hypcrtension complicated by hemorrhagic shock wcrc established by cpidural balloon inflation with saline and rapid discharge of the arterial blood. One hour after the induced shock, the dogs wcrc given HS （6 ml/kg）, RL of 3-fold volume of blood loss, HES of equivalent volume of blood loss, and HSH 8 ml/kg in the 4 groups, respectively. During the shock and rcsuscitationpefiod, the intracranial pressure （ICP）, mean arterial pressure （MAP） and cerebral pcrfusion pressure （CPP） of the dogs wcrc monitored, and the serum sodium level and plasma osmolality wcrc measured at 30min, 1h and 4 h after the resuscitation. Results All dogs had similar MAP, CPP, and ICP before resuscitation （P〉0.05）, After resuscitation, the MAP was significantly improved （P〈0.01）, but the dogs in HSH group cxhibitcd the fastest response; with the cxccptior/of the dogs in HS group to have significantly decreased MAP 2 h after resuscitation （P〈0.01）, all the other dogs maintained the MAP for 4 h. The CPP was also significantly increased after resuscitation （P〈0.01）, and in HS group, CPP decreased significantly after 2 h （P〈0.01）, and HSH group maintained the high CPP after 4 h. The ICP was increased significantly in RL and HES groups after resuscitation （P〈0.0 1）, reaching the peak level at 1 and 3 h, respectively, but in HS and HSH groups, the ICP decreased significantly to the lowest level at 1 h （P〈0.01） which was maintained for 4 h. After resuscitation, the plasma sodium and plasma osmolality wcrc significantly increased in HSH

关 键 词：脑水肿 颅内压 失血性休克 高渗氯化钠羟乙基淀粉40注射液 

分 类 号：R651.15[医药卫生—外科学]