小容量复苏对脑外伤合并休克大鼠脑超微结构和vWF表达的影响  

Effects of small - volume resuscitation with hypertonic - hyperoncotic solutions on brain ultrastructure and expression of von Willevrand factor in traumatic brain injury and hemorrhagic shock model of rats

作　　者：梅弘勋[1] 王恩真[1] 韩如泉[1] 

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100050

出　　处：《中华神经外科杂志》2011年第12期1281-1284,共4页Chinese Journal of Neurosurgery

基　　金：北京市卫生局系统高层次卫生技术人才培养计划（2009-3-19）

摘　　要：目的 观察小容量高晶体-高胶体渗透压混合液（HHS）复苏对脑外伤合并休克大鼠脑超微结构和Ⅷ因子相关抗原（vWF）表达的影响.方法 SD大鼠54只随机分为：（1）假手术组；（2）脑外伤＋休克组；（3）HHS组；每组各18只.脑外伤＋休克组和HHS组建立脑外伤合并急性失血性休克模型,随后在HHS组进行小容量HHS复苏.观察各组脑超微结构和vWF的表达.结果 电镜显示HHS对神经元、星形细胞和血脑屏障均有保护作用.脑外伤＋休克组在损伤后4h和24h vWF的表达显著减少（P＜0.01）,48h开始恢复,但显著低于假手术组和HHS组（P＜0.01）；HHS组在损伤后4h,vWF的表达显著减少（P＜0.0l）,24h开始恢复,至48h恢复正常.结论 小容量HHS复苏治疗脑外伤合并休克大鼠,可以抑制脑血管内皮损伤,促进微血管修复,减轻继发性脑损伤.Objective To evaluate the effects of small -volume resuscitation with hypertonic -hyperoncotic solution （HHS,7.5% NaCl/10% hydroxyethyl starch 200/0.5 ） on brain ultrastructure and expression of yon Willevrand factor in traumatic brain injury （TBI） and hemorrhagic shock model of rats.Methods 54 SD rats were divided into 3 groups：sham operated group （group A,n =18）,TBI and hemorrhagic shock group （group B,n =18） and HHS treatment group （group C,n =18）.All rats in group B and C were subjected to hemorrhagic shock after TBI.The rats in group C were subsequently resuscitated with HHS （4 ml/kg）.The Ultrastructure morphology in cortex and hippocampus CA1 region of injured hemisphere were assessed 4 h after TBI and hemorrhagic shock using electronic microscope.The expression of von Willebrand factor （vWF） was evaluated with immunohistochemical staining.Results It demonstrated that HHS has protective effects on neurons,astrocytes and blood-brain barrier in cortex and hippocampus CA1 region in the model of TBI and hemorrhagic shock in rats.Strong positive immunoreactive microvessels of vWF were found in group A.However,in group B,the expression of vWF was decreased significantly at 4 h and 24 h after TBI and hemorrhagic shock （ P〈0.01）,and increased at48 h after injury,but it was still lower than those in group A and C （ P 〈0.01）.In group C,the expression of vWF was decreased at 4 h after TBI and hemorrhagic shock （ P 〈0.01 ）,then increased at 24 h after injury,and restored to normal level at 48 h after injury.Conclusions In the rat model of TBI and hemorrhagic shock,small- volume resuscitation with HHS could attenuate cerebral injury and improve the repair of endotheliocytes of cerebral vessels.

关 键 词：颅脑损伤 失血性休克 超微结构 VWF 复苏 

分 类 号：R651.1[医药卫生—外科学]