血液滤过用于亚低温治疗脑损伤的动物实验

Hemofiltration used for mile hypothermia therapy post brain injury on animal model

目的通过对血液滤过与传统亚低温疗法效果的比较,探讨其用于外伤性脑水肿的亚低温治疗可行性。方法12只健康犬随机分为2组:血液滤过组(6只),传统降温组(6只)。采用Feeney法自由落体致犬脑损伤,机械通气辅助呼吸。伤后6h,血液滤过组采用血液滤过体外循环降温,血流量为90￣100m L,置换液为500￣800m L/h;传统降温组采用冰敷头部及腹部降温。监测肛温、生命体征、颅内压,检测血气分析以及脑组织水含量变化。结果血液滤过组犬肛温可在15￣18m in后下降并维持在29￣32℃;血液滤过组在开始时平均动脉压低于传统降温组外,电解质和酸碱平衡,氧分压(PO2)、颅内压等指标显著优于传统降温组;外周血乳酸等代谢产物显著低于传统降温组(P<0.05￣0.01),脑组织含水量(77.23%±0.68%)也明显低于传统降温组(79.32%±0.52%)(P<0.05)。结论血液滤过可用于脑损伤后的亚低温治疗,方法安全可行,其降温快速,体温容易控制;另外,血液滤过能调节内环境、清除体内乳酸等炎症递质,对脑组织的保护和减少继发性脑损害有利。

Objective To evaluate the difference of reducing the temperature in CHF between traditional method and describe the method of hemofiltration （HF） used for mild hypothermia in treatment of cerebral edema following head injury. Methods Twelve dogs were randomly assigned into two groups： the hemofiltration group （n=6）, the control group （n=6）, by mean of Feeney＇s head injury animal modal and undergoing mechanical ventilation. After 6 hours post injury, the hemofiltration group underwent hemofiltration, the infusion rate of replacement fluid was about 500-800 L/hr and the blood flow was about 90-100 mL/hr, the control group deeded with ice compress on head and abdominal part. During the treatment, Anus-temperature and vital signs were monitored, blood gas analysis, ICP were measured. The brain water content was finally observed. Results Anus-temperature of the hemofiltration group was descent after 15-18 minute and maintains in range of29-32 ~C. Compared with the control group, it is to maintain in the normal scope in serum acid-base balance, while a significant increase in PO2 and a decrease in ICP. Similarly, there were significant differences between two group in the brain water content （77.23%±0.68% vs.79.32%±0.52%）（P〈0.05）. In addition, HF showed certain clearance of Lactic Acid in group A. Conclusion Hemofiltration can be technically possible in mild hypothermia after severe cerebral damage, by which reduce the temperature speedy and easily to control, enhanced clearance of lactic Acid, stabilized internal environment can be achieved.