HSD与多巴胺伍用对初进高原大鼠失血性休克合并肺水肿的治疗作用  

Beneficial effect of hypertonic saline/dextran in combination with dopamine on hemorrhagic shock with pulmonary edema at high altitude in rats

作　　者：刘良明[1] 胡德耀[1] 刘建仓[1] 李萍[1] 刘厚东[2] 肖南[1] 周学武[1] 田昆仑[1] 霍小萍[1] 石泉贵[2] 何燕梅[2] 殷作明[2] 

机构地区：[1]第三军医大学大坪医院野战外科研究所,重庆400042 [2]西藏军区总医院,西藏拉萨810003

出　　处：《创伤外科杂志》2003年第5期336-339,共4页Journal of Traumatic Surgery

基　　金：军队"十五"攻关课题 (0 1L0 6 5 )

摘　　要：目的　探讨高渗氯化钠右旋醣酐 (7.5 %NaCl 6 %Dextran4 0 ,HSD)与多巴胺 (DA)合用对初进高原大鼠失血性休克合并肺水肿的的治疗效果。方法　初进高原SD大鼠 4 2只 ,复制失血性休克合并肺水肿模型。实验分为非处理组、失血性休克合并肺水肿对照组、乳酸林格氏液对照组 (4ml kg ,LR)、HSD单用组(4ml kg)、多巴胺单用组 (2mg kg ,DA)和HSD与DA合用组 ,每组 7只动物。观察给药后 15、30、6 0和 12 0分钟时相点大鼠血流动力学指标变化、30分钟和 12 0分钟大鼠血气指标变化以及 12 0分钟大鼠肺脑含水量变化。结果　HSD或DA单用可显著升高休克合并肺水肿大鼠血压 (MAP)、左心室内压 (LVSP)和左室内压最大变化速率 (±dp dtmax)等血流动力学指标 (P <0 .0 5～ 0 .0 1) ,改善部分血气指标如pH值、[HCO3- ]、血氧饱和度 (O2 sat)和降低肺、脑含水量。二者合用效果优于两者单用。结论　HSD与DA伍用有较好的改善高原失血性休克合并肺水肿的血流动力学指标 ,改善血气指标和减轻肺水肿的作用 ,可作为治疗高原休克合并肺水肿的早期救治措施之一。Objective To study the effects of hypertonic saline/dextran(7.5%NaCl/6%Dextran40,HSD)in combination with dopamine on hemorrhagic shock with pulmonary edema in the rats just get into high altitude.?Methods Forty two SD rats were transported to LaSa,Tibet which is 3760 meters above the sea level. Hemorrhagic shock model with pulmonary edema was induced by hemorrhage(50 mmHg) plus intravenous injection of oleic acid(5μl/100g wt) for 1 hour. Rats were equally divided into 6 groups(n=7 each group): sham operated group,hemorrhagic shock with pulmonary edema(HSPE),HSPE plus lactated Ringer's solution (LR,4ml/kg),HSD(4ml/kg) alone,DA(2 mg/kg) alone and the combined use of HSD,DA. Hemodynamic parameters including mean arterial blood pressure(MAP),left intraventricular systolic pressure (LVSP) and the maximal change rate of intraventricular pressure rise or decline (±dp/dt max) were observed at 15,30,60 and 120 min,blood gases were observed at 30 and 120 min,and the water content of lung and brain was determined at 120 min after drug administration.?Results HSD(4ml/kg)or DA(2 mg/kg)used alone significantly increased MAP,LVSP and ±dp/dt max(P<0.05～0.01),improved partial variables of blood gases such as pH,[HCO 3 - ] 、blood oxygen saturation and decreased the water content of lung and brain. The combined use of HSD and DA had a better effect.?Conclusion HSD in combination with DA can apparently improve hemodynamic parameters,blood gases,and alleviate pulmonary edema of rats with hemorrhagic shock with pulmonary edema.

关 键 词：失血性休克 肺水肿 HSD DA 血流动力学 大鼠 氯化钠右旋醣酐 多巴胺 治疗作用 

分 类 号：R605.971[医药卫生—急诊医学] R541.63[医药卫生—外科学]