高渗高胶液对肺创伤合并失血性休克兔的脑保护作用  

Brain protection of hypertonic-hyperoncotic solution on pulmonary trauma rabbits combined with hemorrhagic shock

作　　者：胡四平[1] 汪卫星[1] 刘洋[1] 吴鹤芬[1] 余亮[1] 刘鹤[2] 

机构地区：[1]湖州市中心医院麻醉科,313000 [2]徐州医学院江苏省麻醉学重点实验室

出　　处：《中华创伤杂志》2013年第4期368-371,共4页Chinese Journal of Trauma

基　　金：湖州市科技计划基金资助项目（2010YS09）

摘　　要：目的探讨高渗高胶液（4．5g／ml氯化钠联合6．0g／ml羟乙基淀粉，简称HHS）对肺创伤合并失血性休克兔脑保护作用及其可能机制。方法30只新西兰大耳白兔按随机数字表法分为三组：A组为对照组，B组为乳酸林格液（LRS）组，C组为HHS组；每组10只。B、C组建立肺创伤合并失血性休克模型，休克维持60min后，以3倍失血量的LRS和5ml／kg的HHS分别对两组兔进行液体复苏。复苏后4h处死各组动物并取脑组织，荧光显微镜下观察各组脑组织顶叶皮层伊文蓝渗出情况，称量并计算脑含量水，TUNEL法检测凋亡神经元，Westernblot检NBcl一2和Bax蛋白表达。结果与A组比较，B组顶叶皮层有大量伊文蓝渗出，脑含水量显著增加，并出现大量凋亡神经元，Bcl一2和Bax蛋白表达增加，但Bel—2／Bax比例降低（P〈0．01）；与B组比较，C组顶叶皮层伊文蓝渗出明显减少，脑含水量显著降低，凋亡神经元数量减少，Bcl一2／Bax比例显著增高（P〈0．05）。结论HHS通过改善血脑屏障功能、抑制神经元凋亡对肺创伤合并失血性休克兔脑起到一定的保护作用。Objective To investigate effect of hypertonic-hyperoncotic solution （HHS, namely 4.5 g/ml NaC1 plus 6.0 g/m1 hydroxyethyl starch） on brain protection in rabbits with pulmonary trauma combined with hemorrhagic shock and the possible mechanism. Methods Thirty New Zealand white rabbits were randomly divided into control group （Group A）, lactated Ringer＇ s solution （LRS） treatment group （Group B） and HHS treatment group （Group C）, with 10 rabbits per group. Models of pulmonary trauma with hemorrhagic shock were established in Groups B and C. Later, fluid resuscitation, including LRS at 3-fold the volume of blood loss and HHS at dose of 5 ml/kg, was respectively given for Groups B and C at 60 minutes after shock. Rabbits in each group were sacrificed at 4 hours after resuscitation for brain tissue harvest. Evan blue exudation in the parietal cortex of rabbit brain in each group was observed by fluorescence microscope. Brain water content was weighed and calculated. Neuron apoptosis was tested by TUNEL method. Expressions of Bcl-2 and Bax proteins were detected by Western blot. Results Group B showed massive exudation of Evan blue, notable increase of brain water content, large apoptosis of neurons, up-regulation of Bcl-2 and Bax proteins, but a decline of Bcl-2 to Bax ratio, as compared with Group A （P 〈 O. 01 ）. However, Group C showed significant decrease regarding Evan blue exudation, brain water content and apoptotic neurons, and significant increase of ratio of Bcl-2 and Bax, as compared with Group B （P 〈 0.05）. Conclusion HHS improves blood brain barrier, inhibits neuron apoptosis and thus protects brain function.

关 键 词：肺损伤 休克 出血性 高渗溶液 

分 类 号：R655.3[医药卫生—外科学]