氢化可的松对脂肪栓塞综合征血液流变性影响的实验研究

An Experimental Study of the Influence of Hydrocortisone on the Hemorheological Properties in Fat Embolism Syndrome

目的探讨氢化可的松对脂肪栓塞综合征血液流变学特性的影响。方法采用油酸静脉注射法建立脂肪栓塞综合征动物模型，测定实验组（n=20）、对照组（n=20）和健康组（n=10）在24h、48h、72h的全血黏度（-qb）、血浆黏度（-qP）、红细胞压积（HCT）、校正全血黏度（ηb’）、红细胞聚集指数（EAI）、及血小板、纤维蛋白原和动脉血氧分压（PaO2）等指标。结果实验组死亡率为5％，显著低于对照组（35％）。实验组各时间点Pa0：与对照组相比均明显升高（P〈0．05或P〈0．01），但仍低于健康组（P〈0．01）。实验组血小板和纤维蛋白原与健康组相比没有统计学差异，而对照组与实验组和健康组相比，血小板明显减少、纤维蛋白原水平明显增高（P〈0．01）。实验组与健康组之间-11b、11b’无显著性差异（P〉0．05），而对照组与实验组、健康组比较，T1b无显著差异，但ηb’显著增高（P〈0．05或P〈0．01）。实验组各时间点ηP、HCT、EAI与健康组比较，除72h的HCT较低、EAI较高外，其余均无统计学差异（P〉0．05）。对照组与健康组和实验组相比，各时间点nP、EAI均显著增高、HCT均显著下降（P〈0．05或P〈0．01）。结论脂肪栓塞综合征血液多呈高黏滞状态，氢化可的松可降低其血液黏滞度、改善组织供氧，从而改善脂肪栓塞综合征的预后。

Objective To investigate the influence of hydrocortisone on the hemorheological properties in fat embolism syndrome.Methods Animal models of fat embolism syndrome were established by the oleic acid injection method.They were divided into experimental group（n=20）,control group（n--20） and normal group（n=10） randomly.The whole blood viscosity（ qq b）,plasma viscosity（ ~q p）,erythrocyte aggregation index（EAI）,hematocrit value（HCT）,platelet and fibrinogen levels at 24h,48h and 72h of the three groups were determined using the hemorheological detection techniques.Results Mortality rate in the experimental group was 5%,which was obviously lower than that in the control group（35%）.PaO2 at different time points in the experimental group were higher than those in the control group（P 〈 0.05 or P 〈 0.01）,but still lower than those in the normal group（P 〈 0.01）. There were no significant difference between the experimental group and normal group in platelet and fibrinogen levels.However, platelet levels were signifcantly lower while fibrinogen levels significantly higher in the control group compared with the other two groups（P 〈 0.01）.There were no significant difference in ＂q b and ＂q b＇ between the experimental group and normal group.But η b＇ levels in the control group were significantly higher than those in the experimental group amd normal group（P 〈 0.05 or P 〈 0.01）.There were no significant differences in η p, HCT, EAI between the experimental group and control group（P 〉 0.05） except that HCT were lower and EAIwere higher at 72h（P 〈 0.05）. -q p and EAI levels in the control group were significantly higher and HTC were significantly lower than those in the experimental and normal group（P 〈 0.05 or P 〈 0.01）.Conclusions The blood is in a hyperviscous state in fat embolism syndrome.Hydrocortisone can reduce the blood viscosity, improve the oxygen supply of tissues,and then improve the prognosis of fat embolism syndrome.