甘露醇和高渗盐水缓解家兔颅内高压的效果比较

Comparison of mannitol and hypertonic saline in treatment of intracranial hypertension of rabbits

目的:比较等渗透摩尔浓度的20%甘露醇和7.5%NaCl溶液降低颅内高压的效果,以及比较等体积量的高渗盐水7.5%NaCl溶液和23.4%NaCl溶液降低颅内高压的效果。方法:通过侧脑室插管灌注恒定压力的人工脑脊液建立家兔颅内高压模型,观察一定剂量的上述三种高渗溶液,分别对颅内高压家兔的平均动脉压、呼吸频率、潮气量、人工脑脊液灌流速度和脑含水率的影响。结果:当颅内压力从15 cmH2O升高到75 cmH2O时,家兔的平均动脉压升高,潮气量降低;经上述三种高渗溶液分别治疗后,家兔的平均动脉压,呼吸频率和潮气量在颅内高压前后的变化率与对照模型组比均无显著差异;经20%甘露醇5 ml/kg体重治疗或23.4%NaCl溶液2.2 ml/kg体重治疗后,颅内高压家兔的人工脑脊液灌流速度显著增加,脑含水率显著地降低,但两高渗溶液之间没有效应的差异;与对照组相比,7.5%NaCl溶液不能明显改变脑脊液的灌流速度和脑含水率。结论:在等渗透摩尔浓度下,20%甘露醇降颅内高压的效果要优于7.5%NaCl溶液;使用更高渗透摩尔浓度的高渗盐水23.4%NaCl溶液,能有效地降低颅内高压,可以替代甘露醇。

Objective： To compare the effects of mannitol and hypertonic saline（HS） in treatment of intracranial hypertension（ICH） of rabbits.Methods： The animal mode of ICH was established by perfusing artificial cerebrospinal fluids（aCSF） with controlled pressure into the cerebral ventricles of rabbits.The mean arterial pressure,respiratory rate,tidal volume,perfusion rate of aCSF and water content of cerebrum were investigated in rabbits with ICH after a single bolus of 20% mannitol（5 ml/kg）,7.5% HS（2.2 ml/kg） or 23.4% HS（2.2 ml/kg）.Results： After the intracranial pressure was elevated from 15 cmH2O to 75 cmH2O,the mean arterial pressure was increased and the tidal volume was decreased.After treatment by 20% mannitol,7.5% HS or 23.4% HS,the increased percentage of mean arterial pressure and the decreased percentage of tidal volume were similar to the changes in control group.However,the perfusion rate of CSF was increased and water content of cerebrum was decreased after treatment by either 20% mannitol or 23.4% HS,but not by 7.5% HS.No different effects were found between 20% mannitol and 23.4% HS.Conclusions： With the similar osmotic burden,20% mannitol is more effective in treating ICH than 7.5% HS.With higher osmotic load,the efficacy of HS is enhanced,and 23.4% HS may be used as an alternative to mannitol in treatment of ICH.