不同粘度血浆扩容剂的制备及其在失血性休克中的应用

目的:制备不同粘度的血浆扩容剂,初步研究其在失血性休克治疗中的作用。方法:采用海藻酸钠和右旋糖酐70制备高粘度血浆扩容剂(HVPE),采用右旋糖酐70制备低粘度血浆扩容剂(LVPE);采用间断放血方法制备失血性休克大鼠模型。用两种血浆扩容剂对休克大鼠进行复苏,同时监测平均动脉压、动物存活情况,红细胞压积、血红蛋白含量、血气、全血粘度、血浆乳酸浓度、胶体渗透压等指标。结果:HVPE和LVPE的胶体渗透压分别为42.5mmHg和60.1mmHg。二者分别表现出剪切稀化和剪切稠化等非牛顿流体特性。复苏后90min,HVPE组和LVPE组大鼠存活率分别为57%和100%。HVPE组存活和死亡动物血浆粘度平均值分别为2.37和3.54mPa.S。在纠正酸中毒和改善碱剩余方面,HVPE不如LVPE。其它各项指标两组无显著性差异。结论:失血性休克治疗中,血浆粘度应该控制在合适范围内,过高的血浆粘度可能引起死亡。

Preparation of Different Viscosities Plasma Expander and Their Application in Hemorrhagic Shock

Objective:The aim of this study was to prepare plasma expander of different viscosities and to test the effects of them in hemorrhagic shock.Method:We apply sodium alginate and dextran 70 to prepare(HVPE)and low viscosity plasma expander(LVPE).Colloidal osmotic pressure and viscosity of them were tested.Rat models of hemorrhagic shock were made,HVPE and LVPE were used for resuscitation.Mean arterial pressure was monitored and survival time was observed.Systemic hematocrit(Hct),content of hemoglobin(Hb),blood gas,lactate,plasma colloidal osmotic pressure,blood and plasma viscosity were tested.Results:Colloidal osmotic pressure of HVPE and LVPE were 42.5 and 60.1mmHg,respectively.Both of them were non-Newtonial fluid.HVPE show shear thin,while LVPE show shear thick.Survival rate of HVPE and LVPE were 57% and 100% 90 minutes after the resuscitation.The average level of the plasma viscosity of survivals and deaths in HVPE group were 2.37 and 3.54 mPa·s,respectively.PH and base excess(BE)show less improvement in HVPE group compared with LVPE group.Conclusion:Appropriate plasma viscosity in hemorrhagic shock is needed to be investigated,too high plasma viscosity can cause death.