质量浓度为75g/L的高渗盐水对兔脑梗死后平均动脉压、颅内压及脑灌注压的影响

Effect of 75 g/L hypertonic saline on mean arterial blood pressure,intracranial pressure and cerebral perfusion pressure of rabbits with cerebral infarction

目的:评估75g/L的高渗盐水对兔大脑中动脉梗死后平均动脉压、颅内压及脑灌注压的影响,并与甘露醇治疗进行比较。方法:实验在武汉大学人民医院神经科实验室完成。取新西兰白兔20只,线栓法制备大脑中动脉梗死模型,随机分为两组,在梗死后6h分别开始静脉推注75g/L的高渗盐水和甘露醇。从用药前开始持续监测颅内压、平均动脉压(MBP)10h,并计算出脑灌注压;用药前及用药后15,30,60min,检测血钠离子浓度及血浆渗透压。结果:两组治疗后15min左右MBP达峰值,以后迅速下降回到基线,两组在各时间段比较差异无显著性意义(P>0.05)。颅内压明显降低,75g/L盐水组在30min降到最低点(下降了7.9mmHg,1mmHg=0.133kPa),甘露醇组在30min降到最低点(下降了5.1mmHg),此后颅内压渐上升。75g/L的盐水组脑灌注压在5～180min较治疗前显著升高(P<0.05);甘露醇组脑灌注压在5～120min较治疗前显著升高(P<0.05),480min后较治疗前显著降低(P<0.05)。结论:单次使用75g/L的高渗盐水能迅速降低颅内压,升高脑灌注压,与相似渗透压的甘露醇比较,降低颅内压的维持时间更长。

AIM:To evaluate the effects of 75 g/L hypertonic saline on mean arterial blood pressure(MBP),intracranial pressure(ICP) and cerebral perfusion pressure(CPP) of rabbits with cerebral infarction for comparison with mannitol therapy.METHODS:The experiment was performed in the Department of Neurology,People's Hospital of Wuhan University.Twenty rabbits were randomly divided into two groups after making model of middle cerebral artery infarction.The rabbits were injected with 75 g/L hypertonic saline or mannitol 6 hours after infarction. ICP,MBP,and CPP were monitored for 10 hours.Blood osmolarity and sodium ionic concentration were also measured before infusion and 15, 30 and 60 minutes after infusion. RESULTS:The MBP in the two groups reached to the peak at 15 minutes after infusion, and then decreased to the baseline quickly,and there was no significant difference between the two groups(P >0.05).The ICP decreased significantly to the baseline(decreased by 7.9 mm Hg,1 mm Hg=0.133 kPa) at 30 minutes after infusion in 75 g/L hypertonic saline group,and decreased 5.1 mm Hg in mannitol group.Thereafter,ICP began to return.In 7.5% hypertonic saline group,CPP increased significantly than that before treatment from 5 to 180 minutes(P< 0.05). In mannitol group,CPP were higher than that before treatment from 5 to 120 minutes and lower after 480 minutes(P< 0.05). CONCLUSION:Infusion of 75 g/L hypertonic saline can decrease the ICP and increased the CPP in rabbits with middle cerebral artery occlusion.As compared with the mannitol,the time in decreasing the CPP will last longer in hypertonic saline.