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高渗氯化钠羟乙基淀粉40溶液复苏对TBI患者炎症与凝血机制的影响 被引量:1

Prehospital Resuscitation with Hypertonic Sodium Chloride Hydroxylethy Starch40(HSH) to Effect of Inflammatory,Clotting and Endothelial Active Marker in Severe Cerebral Trauma Patients
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摘要 目的:创伤性脑损伤(traumatic brain injury,TBI)可引起炎症和凝血异常,诱导白细胞和内皮细胞黏附分子释放,高渗盐水是TBI复苏的有效药物,本研究评价高渗液体对TBI的炎症和凝血机制的影响。方法:前瞻对照研究,对重症TBI(GCS<8)患者应用高渗氯化钠羟乙基淀粉40溶液(HSH)或0.9%生理盐水(NS),检测细胞和可溶性炎症性凝血标志物。60例患者(HSH30例,NS30例)在住院时、复苏后12h、24h和48h采集血标本,应用流式细胞仪分析白细胞表面黏附(CD62L,CD11b)分子。检测可溶性L-和E选择素、血管和细胞间黏附分子(sVCAM-1、sICAM-1)、肿瘤坏死因子(TNF)-α与白细胞介素(IL-10)、D-二聚体(D-D)。26例健康成人作为对照组。结果:与对照组相比,NS组患者多核心粒细胞(PMNs)与单核细胞表达CD62L、CD11b增高2倍,持续48h;HSH患者细胞表面活性黏附分子在所有检测时间点均接近对照组水平,而且患者的sVCAM-1和E选择素逐渐降低。NS组循环L-选择素水平12h和48h显著升高,而HSH组24h不升高。所有患者的TNF-a和IL-10水平均高于对照组,但HSD组较低。D-D水平HSH组亦显著降低。结论:HSH复苏可显著降低TBI患者白细胞和内皮细胞的促炎促凝介质,对于改善重症TBI的临床预后有益。 Objective:Traumatic brain injury(TBI) can cause turbulence of inflammatory and coagulation,induced white blood cells and endothelial cell adhesion molecule release,hypertonic saline is effective for TBI patients resuscitation,the study was evaluated the effect of the hypertonic liquid to inflammatory and coagulation on the TBI patients.Methods:This prospective and case-control study investigated the impact of pre-hospital resuscitation of severe TBI(GCS8) patients using hypertonic sodium chloride hydroxylethy starch40(HSH,n=30) or 0.9% normal saline(NS,n=30),to detect the markers of cells and soluble inflammatory/coagulation.Serial blood samples were drawn from patients at the time of hospital admission and at 12h,24h,and 48h post-resuscitation.Used flow cytometry to analyzed leukocyte surface adhesion(CD62L,CD11b) molecules.Circulating concentrations of soluble L-and E-selectins,vascular and intercell-ular adhesion molecules(sVCAM-1,sICAM-1),tumor necrosis factor(TNF)-a and in terleukin(IL-10),and D-dimers(D-D) were assesse d by enzyme immunoassay.26 healthy adults were studied as control group.Results:Compared with the control,NS group showed up to a 2-fold higher surface expression of CD62 L and CD11b on polymorphonuclear neutrophils(PMN s) and monocytes that persisted for 48h.HSH patients cell surface active adhesion molecule in all time points are close to the level of control group,and the patients sVCAM-1 and E–selectins to gradually reduce.Circulating L-selectin levels with NS patients were significantly elevate d at 12h and 48h,but not 24h post-resuscitation with HSH.TNF-a and IL-10 levels in all patients are higher than those in the control group,but the HSH group is lower than NS group.D-D level in HSH group also significantly reduced.Conclusion:Prehospital resuscitation with hypertonic sodium chloride hydroxylethy starch40(HSH)can significantly attenuating the upregulation of leukocyte/endothelial cell proinflammatory/prothrombotic mediators in TBI patients,which was clinical prognosis beneficial for the severe TBI patients.
作者 朱海龙
出处 《中国医药导刊》 2012年第11期1937-1938,共2页 Chinese Journal of Medicinal Guide
关键词 重症脑损伤 液体复苏 高渗盐 炎症介质 Severe traumatic brain injury Resuscitation Hypertonic sodium chloride Inflammatory cytokines
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