高渗羟乙基淀粉对脑缺血大鼠颅内压的影响及机制探讨  

Effects and its mechanisms of hypertonic saline hydroxyethyl starch 200/0.5 solution in rats with ischemic cerebral edema

作　　者：袁向东[1] 江稳强[1] 蒋鑫[2] 朱高峰[1] 曾红科[1] 

机构地区：[1] 广东省人民医院(广东省医学科学院)急诊科,广州510080 [2]广东省人民医院(广东省医学科学院)急诊科 南方医科大学研究生学院,广州510080

出　　处：《中华急诊医学杂志》2015年第3期299-303,共5页Chinese Journal of Emergency Medicine

基　　金：国家临床重点专科建设项目（2012649）

摘　　要：目的 探讨高渗羟乙基淀粉200/0.5氯化钠注射液对脑缺血-再灌注大鼠颅内压和脑水肿的影响及可能机制.方法 采用随机对照动物实验研究方法,实验在中山大学实验动物中心进行.取28只雄性SD大鼠,随机（随机数字法）分为高渗羟乙基淀粉组、羟乙基淀粉组、对照组和假手术组.右侧大脑中动脉阻塞（middle cerebral artery occlusion,MCAO）法建立脑梗死再灌注大鼠模型,造模不成功另选大鼠再行手术补足手术组,于再灌注开始时尾静脉泵入高渗羟乙基淀粉200/0.5氯化钠注射液和羟乙基淀粉130/0.4氯化钠注射液,分别为206 mL/ （kg· d）;造模后0、2、6、12、18、24 h时间点分别测量血浆胶体渗透压（plasma colloid osmotic pressure,COP）和颅内压（intracranial pressure,ICP）;治疗24 h后测量右侧大脑半球含水量（brain water content,BWC）.结果 高渗羟乙基淀粉组、羟乙基淀粉组和对照组术后各时间点ICP均显著高于假手术组;高渗羟乙基淀粉组术后ICP明显低于对照组和羟乙基淀粉组,但羟乙基淀粉组各时间点ICP和对照组比较差异无统计学意义.高渗羟乙基淀粉组和羟乙基淀粉组COP各时间点均显著高于对照组和假手术组,高渗羟乙基淀粉组和羟乙基淀粉组间差异均无统计学意义.高渗羟乙基淀粉组、羟乙基淀粉组和对照组脑含水量均显著高于假手术组[（81.24±0.36）％、（83.04±0.10）％、（83.14±0.41）％ vs.（78.37±0.37）％,P=0.000];高渗羟乙基淀粉组脑含水率显著低于对照组[（81.24±0.36）％ vs.（83.14±0.41）％,P=0.000）]和羟乙基淀粉组[（81.24±0.36）％ vs.（83.04±0.10）％,P=0.000];羟乙基淀粉组和对照组比较差异无统计学意义[（83.04±0.10）％vs.（83.14±0.41）％,P=0.578].结论 高渗羟乙基淀粉可明显改善脑缺血-再灌注大鼠急性期脑水肿、降低颅内压,但未能证实其提高COP对颅内压和脑水肿的影响.Objective To investigate effects and its mechanisms of hypertonic saline hydroxyethyl starch 200/0.5 solution on intracranial pressure and brain water content in rats with ischemic cerebral edema.Methods All experiments were conducted in the animal experimental center of Sun Yat-sen University.The 28 male Sprague-Dawle （SD） rats were randomly （random number） divided into hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group,control group and sham operation group,each n =7.Ischemic cerebral edema model was reproduced by middle cerebral artery occlusion （MCAO）,followed by reperfusion after ischemia for 2 hours （If the moldel was not successful,other rats were operated to fill the missing models）.Then reperfusion after ischemia 2 hours and received hypertonic saline hydroxyethyl starch and hydroxyethyl starch via tail vein at the beginning of reperfusion.The colloidal osmotic pressure （COP） and intracranial pressure （ICP） were evaluated on 0,2,6,12,18,24 hours after the surgery.The water content of the right hemisphere was measured on 24 h after the surgery.Results The ICP of hypertonic saline hydroxyethyl starch group,hydroxyethyl starch group and control group were significantly higher than that of sham operation group on 2,6,12,18,24 h after the surgery.The ICP of hypertonic saline hydroxyethyl starch group was significantly lower than those of hydroxyethyl starch group and control group on 2,6,12,18 and 24 h.But there was no significant difference in ICP of the hydroxyethyl starch group compared with that of control group at all time points.The COP of hypertonic saline hydroxyethyl starch group and hydroxyethyl starch group were significantly higher than the control group and sham operation group at each time point; There was no significant difference in COP （mmHg） of the hydroxyethyl starch group compared with that of hypertonic saline hydroxyethyl starch group at all time points.The brain water content （BWC） of hypertonic saline hydroxyethyl starch group,hydroxye

关 键 词：高渗羟乙基淀粉 缺血-再灌注损伤 脑 胶体渗透压 颅内压 脑水肿 

分 类 号：R743[医药卫生—神经病学与精神病学]