高渗盐溶液经骨髓腔通路复苏失血性休克犬的骨髓细胞学及病理学改变  

The change in bone marrow after intraosseous hypertonic saline-hydroxyethyl starch infusion for resuscitation of hemorrhagic shock in dog

作　　者：谢菲[1] 侯克东[3] 宋青[1] 江朝光[2] 

机构地区：[1]解放军总医院外科重症监护科,北京100853 [2]解放军总医院医务部,北京100853 [3]北京平谷区医院

出　　处：《中国危重病急救医学》2010年第5期309-312,I0002,共5页Chinese Critical Care Medicine

基　　金：全军医药卫生科研基金课题（08G122）

摘　　要：目的观察不同复苏液经骨髓腔通路复苏失血性休克后骨髓细胞学及病理学改变。方法按随机数字表法将18只犬均分为假手术组、生理盐水组、高渗盐溶液组[即7．5％氯化钠-6％羟乙基淀粉40溶液（HSH）组]。生理盐水和HSH组动物建立犬失血性休克模型，经胫骨骨髓腔快速（5min内）按4ml／kg分别推注生理盐水或HSH进行复苏；假手术组动物不进行放血和输液处理。于复苏前后取外周静脉血和骨髓液计数CD34＋阳性率，骨髓涂片染色进行细胞分类及病理观察。结果复苏后48h，HSH组静脉血及骨髓液CD34＋阳性率均高于生理盐水组[静脉血：（6．915±1．178）％比（4．848±0．527）％，骨髓液：（7．900±0．648）％比（6．875±0．403）％，均P〈0．053。复苏后1周，与假手术组相比，生理盐水组红细胞系、粒细胞系细胞比例均显著升高（红细胞系：0．289±0．016比0．253±0．014，粒细胞系：0．615±0．019比0．560±0．013，均P〈0．05），淋巴细胞系细胞比例显著下降（0．049±0．007比0．132±0．015，P〈0．05）；HSH组红细胞系（0．273±0．012）和淋巴细胞系比例（0．162±0．014）均显著升高（均P〈0．05），而粒细胞系比例（0．517±0．038）显著下降（P〈0．05）。生理盐水组和HSH组4周后骨髓各造血细胞系恢复至正常；骨髓病理观察表明输液后骨髓改变轻微，未见坏死细胞。结论经骨髓腔通路输注小剂量HSH复苏失血性休克犬后，骨髓改变轻微，是一种安全、有效的复苏方案。Objective To observe the change in bone marrow after intraosseous hypertonic saline- hydroxyethyl starch （HSH） in dogs with hemorrhagic shock. Methods Eighteen male dogs were randomly divided into sham group, normal saline （NS） group （0.9%sodium chloride） and HSH group （7.5% sodium chloride-6 % hydroxyethyl starch）. Wiggers graded controlled hemorrhagic shock model was reproduced in NS and HSH groups, and above solutions were injected into bone marrow of the tibia in low dosage （4 ml/kg） rapidly （within 5 minutes）. The sham group did not lose blood or receive infusion. CD34＋ expression of peripheral blood and bone marrow, and the change in picture of different hematopoietic series in bone marrow were examined before and after bone marrow resuscitation. Pathological change in bone marrow was examined after different resuscitation fluid infusion. Results After 48 hours of resuscitation, the percentage of CD34＋ in bone marrow and peripheral blood in HSH group were significantly higher than that of NS group [peripheral blood： （6. 915 ± 1. 178）% vs. （4. 848± 0. 527）%, bone marrow： （7. 900 ±0. 648）%vs. （6. 875±0. 403）%, both P〈0. 05]. One week after resuscitation, the erythroeyte count and granuloeytic count in NS group were significantly increased compared with sham group （erythroeyte count： 0. 289±0. 016 vs. 0. 253±0. 014, granulocytic count： 0. 615±0. 019 vs. 0. 560±0. 013, both P〈0. 05], lymphocytic count was significantly decreased （0. 049±0. 007 vs. 0. 132±0. 015, P〈0. 05）. In the HSH group, erythrocyte count （0. 273±0. 012）, lymphocytic count （0. 162±0. 014） were all significantly increased （both P〈0. 05）, while granuloeytic count （0. 517±0.038） was significantly decreased （P 〈 0.05）. After 4 week of resuscitation, the change in hemopoiesis series in NS group and HSH group recovered to normal level. The bone marrow morphology changed slightly, and no bone necrosis occurred. Conclusion HSH in small amour through i

关 键 词：休克 失血性 骨髓 输液 高渗盐液 

分 类 号：R459.7[医药卫生—急诊医学]