四种不同复合液对急性颅内高压伴失血性休克兔复苏的效果及其机制

目的 探讨4种不同复合液体对急性颅内高压伴失血性休克兔复苏的效果及机制.方法 家兔24只,随机分为甘露醇羟乙基淀粉组( MT+ HS)组、甘露醇低分子右旋糖酐组(MT+HD)组、7.5％高渗氯化钠羟乙基淀粉组(HSH)组、7.5％高渗氯化钠低分子右旋糖酐组(HSD)组,每组6只,采用硬膜外球囊注水和动脉放血的方法复制急性颅内高压伴失血性休克模型,分别于8个不同时点采集平均动脉压(MAP)、中心静脉压(CVP)、颅内压(ICP)、脑灌注压(CPP)数据.结果 4组复合液均能提高MAP,HSH组在复苏后20 min达到峰值,反应速度最快,提高MAP的平均幅度分别为(29.4±2.1)、(27.9±3.4)、(41.0±2.2)、(40.6±1.6) mm Hg(1 mm Hg =0.133 kPa),提高幅度差异有统计学意义(P＜0.05)；4组复合液提高CVP值的幅度均接近于(3.0±1.4) cm H2O(1 cm H2O =0.098 kPa),提高幅度差异无统计学意义(P＞0.05)；4组复合液均能在不同时段将ICP值降至基础值水平(7.3±1.6) mmHg,将CPP值升至基础值水平(69.6±6.8)mm Hg,峰值水平差异无统计学意义(P＞0.05).结论 4组复合液均有纠正休克和降低颅内压的效果,HSH维持效用的时间最持久,复苏效果最明显.

Effects and mechanisms of four different complex solutions on acute intracranial hypertension complicated by hemorrhagic shock resuscitation in rabbits

Objective To observe the effect of four different solutions in treatment of acute intracranial hypertension complicated by hemorrhagic shock in rabbits,and explore their mechanisms.Methods Twenty four rabbits were randomized into four equal groups,namely the mannitol hydroxyethyl starch ( MT + HS) group,mannitol low molecule dextran ( MT + HD) group,7.5％ hypertonic sodium chloridehydroxyethyl starch (HSH) group,7.5％ hypertonic sodium chloride low molecule dextran (HSD) group.Cannie models of acute intracranial hypertension complicated by hemorrhagic shock in rabbits were established by epidural ballon inflation with saline and rapid discharge of the arterial blood.Monitor mean arterial pressure (MAP),central venous pressure (CVP),ICP,CPP before starting the experiment (E1),after epidural ballon inflation ( E2 ),during shock phase after rapid discharge of the arterial blood ( E3 ),20min after shock ( F4 ),20min after resuscitation ( T1 ),40 min after resuscitation ( T2 ),1 h after resuscitation (T3),2 h after resuscitation (T4),respectively.Results All four solutions can effectively increase MAP.20 min after resuscitation,MAP values of rabbits in HSH group show the fastest response to reach peak.They display an average of improvement of ( 29.4 ± 2.1 ),( 29.4 ± 2.1 ),(41.0 ± 2.2),(40.6 ± 1.6) mm Hg ( 1 mm Hg =0.133 kPa) in MAP,respectively.The difference of improvement has statistical significance( P ＜ 0.05 ) ; All four complex solutions can improve about ( 3.0 ± 1.4) cm H2O (1 cm H2O =0.098 kPa) in CVP,and the difference of improvement has no statistical significance( P ＞0.05) ;All four complex solutions can decrease ICP value to the baseline level (7.3 ± 1.6) mm Hg and increase CPP value tothe base-line level ( 69.6 ± 6.8 ) mmHg at different time points.The difference of their peak values show no statistical significance(P ＞ 0.05).Conclusion All four solutions can effectively resuscitate hemorrhagic shock and decrease ICP.HSH has the longest-lasting effect and shows the best result from resuscitation of hemorrhagic shock.