羟乙基淀粉对脑缺血/再灌注大鼠颅内压及血浆胶体渗透压的影响  

Effect of hydroxyethyl starch on intracranial pressure and plasma colloid osmotic pressure in rats with cerebral ischemia/reperfusion injury

作　　者：蒋鑫[1] 陈纯波[2] 方明[2] 江稳强[2] 朱高峰[1] 曾红科[2] 

机构地区：[1]南方医科大学研究生学院,广东广州500180 [2]广东省人民医院急危重症医学部

出　　处：《中国危重病急救医学》2011年第3期166-168,193,共4页Chinese Critical Care Medicine

基　　金：广东省自然科学基金面上项目（8151008004000010）

摘　　要：目的 探讨羟乙基淀粉对脑缺血/再灌注（I/R）大鼠血浆胶体渗透压（COP）的调节作用及其对颅内压（ICP）的影响.方法 采用随机对照动物实验研究方法,将24只雄性SD大鼠分为假手术组、模型组和羟乙基淀粉组,每组8只.采用大脑中动脉闭塞法（MCAO）建立脑I/R动物模型,于缺血2 h后再灌注,再灌注开始时尾静脉泵入羟乙基淀粉130/0.4氯化钠注射液206 ml·kg-1·d-1.于术后0、2、6、12、18、24 h分别测定ICP和COP;术后24 h测量右侧大脑半球含水量,用免疫组化法观察神经元凋亡情况.结果 模型组和羟乙基淀粉组术后2 h ICP（mm Hg,1 mm Hg=0.133 kPa）即显著高于假手术组（11.50±1.43、12.48±0.75比7.95±0.92,均P＜0.05）,之后随时间延长,两组ICP逐渐升高,至24 h达峰值（22.76±0.72、23.32±0.98比8.15±1.09,均P＜0.05）;但羟乙基淀粉组与模型组各时间点比较均无差异.羟乙基淀粉组术后各时间点COP（mm Hg）显著高于模型组和假手术组,于术后6 h达高峰（13.49±0.50比12.04±0.47、12.00±0.39,均P＜0.01）;模型组与假手术组各时间点比较均无差异.羟乙基淀粉组和模型组脑组织含水量、神经元凋亡率均显著高于假手术组[脑组织含水量：（80.16±0.44）%、（80.59±0.67）%比（78.72±0.52）%;神经元凋亡率：（44.27±7.86）%、（42.82±7.82）%比（3.26±0.00）%,P＜0.05或P＜0.01];但羟乙基淀粉组与模型组比较差异无统计学意义（均P＞0.05）.结论 羟乙基淀粉可以有效提高COP,但尚不能证实提高COP是否能够降低ICP、减轻脑水肿.Objective To investigate the regulatory effect of hydroxyethyl starch on colloidal osmotic pressure（COP）, and its effect on intracranial pressure（ICP）in rats with cerebral ischemia/reperfusion （I/R）injury. Methods Twenty-four male Sprague-Dawley（SD）rats were randomly divided into sham operation group, model group and the hydroxyethyl starch group, each n = 8. Cerebral I/R model was reproduced by middle cerebral artery occlusion（MCAO）, followed by reperfusion after ischemia for 2 hours.Rats in hydroxyethyl starch group received hydroxyethyl starch 130/0. 4 206 ml · kg-1 · d-1 via tail vein at the beginning of reperfusion. ICP and COP were evaluated at 0, 2, 6, 12, 18, 24 hours after the surgery.The rats were sacrificed by decapitation. The water content of the right hemisphere was measured at 24 hours after the surgery, and the ratio of apoptosis of neurons was observed by immunohistochemical method. Results Two hours after surgery the ICP（mm Hg, 1 mm Hg=0.133 kPa）of model group and hydroxyethyl starch group was significantly increased compared with sham operation group（11. 50±1.43,12. 48±0. 75 vs. 7. 95±0. 92, both P〈0. 05）. With prolongation of time, the ICP gradually increased and reached the peak at 24 hours（22. 76±0. 72, 23. 32±0. 98 vs. 8. 15±1.09, both P〈0. 05）. But there was no significant difference in ICP in the hydroxyethyl starch group compared with that of the model group at all time points. The COP（mm Hg）of hydroxyethyl starch group was significantly higher than the model group and sham operation group at each time point, and peaked at 6 hours after surgery（13. 49±0. 50 vs. 12.04±0. 47, 12. 00±0. 39, both P〈0. 01）. There was no significant difference in COP between the model group and the sham operation group at all time points. The brain water content, neuronal apoptosis of hydroxyethyl starch group and model group was significantly higher than sham operation group[brain water content：（80. 16 ± 0. 44）%,（80. 59 ± 0. 67）% vs.（78. 7

关 键 词：羟乙基淀粉 缺血/再灌注损伤 脑 胶体渗透压 颅内压 脑水肿 

分 类 号：R743.3[医药卫生—神经病学与精神病学]