高渗氯化钠羟乙基淀粉复合液对失血性休克肺的保护作用

目的观察用高渗氯化钠羟乙基淀粉复合液(7.5%氯化钠 6%羟乙基淀粉200/0.5,HHS)小容量复苏对失血性休克后肺损伤的影响。方法雄性SD大鼠随机分为五组:正常对照组(CON组,n=6):不放血不补液;其他大鼠通过放血使MAP降至45mmHg并维持120min,然后分为:休克组(SH组,n=6),不补液复苏;HHS组(n=8),用HHS5ml/kg静脉滴注;7.5%氯化钠高渗溶液组(HTS组,n=6),用7.5%NaCl5ml/kg静脉滴注;复方乳酸钠组(LR组,n=7),用3倍失血量的复方乳酸钠静脉滴注。观察休克2h末、补液结束即刻、15、30、60、120、180min时MAP、CVP的变化,测定补液结束2、24h存活动物的氧合指数和肺水含量、肺髓过氧化物酶(MPO)水平、肺损伤评分。结果在补液结束120、180min,HTS组MAP、CVP低于HHS和LR组(P<0.05);在补液结束24h,HHS组氧合指数、肺水含量、肺MPO水平、肺损伤评分优于HTS和LR组(P<0.05)。结论用HHS小容量复苏失血性休克,维持血流动力学稳定时间更长;对肺组织的保护作用优于7.5%氯化钠高渗溶液或复方乳酸钠。

Hypertonic saline plus hydroxyethyl starch alleviates lung injury in rats with hemorrhagic shock

Objective To investigate the effect of the low volume resuscitation with hypertonic saline combined with hydroxyethyl starch(200/0.5) solution(HHS) on lung injury in rats with hemorrhagic shock.Methods Thirty three male SD rats were randomly divided into five groups.The rats in sham shock(CON,n=6) group(had no bleeding and infusion).The rats of others experienced hemorrhagic shock by withdrawing blood to MAP of 45 mmHg for 120 min,then were divided into shock group(SH group,n=6,with no infusion),HHS group(n=8,infusion with 5 ml/kg HHS iv),hypertonic saline(HTS) group(n=6,infusion with 5 ml/kg 7.5%NaCl iv),and lactate Ringer's solution group(LR group,n=7,transfusion with three times of the volume of withdrawn blood).MAP and CVP were recorded at the 2 h after end of hemorrhagic shock,and 15,30,60,120,180 min after infusion.Oxygenation indexes(PaO2/FiO2) at 2 and 24 h,lung water content,pulmonary myeloperoxidase(MPO) level,and lung damage scores of survival rats at 24 h were assessed respectively after infusion.Results MAP and CVP of HTS group were significantly lower than those of HHS and LR groups at 120,180 min after infusion(P<0.05).PaO2/FiO2,lung water content,pulmonary MPO level,and lung damage scores in HHS group were all better significantly than those in HTS and LR groups at 24 h after infusion(P<0.05).Conclusion The use of HHS for resuscitation of hemorrhagic shock is better than HTS or LR in maintaining stable hemodynamics and alleviating lung injury induced by hemorrhagic shock after resuscitation.