不同复苏压力对颅脑创伤合并非控制性失血性休克大鼠血流动力学及存活率的影响

Proper target pressure to resuscitate uncontrolled hemorrhagic shock with traumatic brain injury in rats

目的探讨颅脑创伤合并非控制性失血性休克大鼠彻底止血前的理想复苏压力。方法制作大鼠颅脑创伤合并非控制性失血性休克模型,观察彻底止血前不同复苏压力(50 mmHg、60 mmHg、70 mmHg、80 mmHg和90 mmHg)对输液量、失血量、血流动力学、大脑灌注以及动物存活率的影响。结果不同复苏压力对颅脑创伤合并非控制性失血性休克的失血量有明显的影响,随着复苏压力的增加,大鼠的失血量、输液量逐渐增加,当复苏压力大于80 mmHg时,其失血量和输液量显著高于70 mmHg。当复苏压力小于70 mmHg时,随着复苏压力增加,脑含水量和血流量逐渐增加,70 mmHg复苏组脑含水量接近假手术组,而80 mmHg和90 mmHg组的血流量反而下降。血压维持在50 mmHg、60 mmHg、70 mmHg动物的存活时间和存活率明显高于常压(80 mmHg和90 mmHg)复苏组;50 mmHg、60 mmHg、70 mmHg组的血流动力学指标明显得到改善。结论对于颅脑创伤合并非控制性出血性休克,最理想的复苏压力是70 mmHg,它能改善血流动力学,降低脑水肿,提高动物存活率。

Abjective To investigate the effect of different resuscitation pressure for hemodynamics and survival rate of traumatic brain injury （TBI） combined with uncontrolled hemorrhagic shock（UHS） in rats. Methods With the rat model of combined TBI and UHS, we investigated the effects of a series of target resuscitation MAP （50 mmHg,60 mmHg,70 mmHg,80 mmHg and 90 mmHg） before controlling of bleeding on animal blood loss, fluid requirment, survival, brain perfusion and hemodynamics. Results Different target resuscitation pres- sure played an important role of TBI combined with UHS in rats＇ blood loss. With the increasing of target resuscitation pressure, the blood loss and fluid requirement increased. When the resuscitation pressure was up to 80 mmHg,the blood loss and fluid requirement were signifi- cantly higher than those of 70 mmHg. When the resuscitation pressure was low to 70 mmHg, with the increasing of target resuscitation pres- sure, the brain water content and brain blood flow were increasing. The brain water content of 70 mmHg approached to sham operation, but the blood flow of 80 mmHg and 90 mmHg were descent. The animal survival rates of 50 mmHg,60 mmHg,70 mmHg were higher than those of 80 mmHg and 90 mmHg. The hemodynamics of 50 mmHg,60 mmHg,70 mmHg were stable. Conclusion 70 mmHg is the ideal target resuscitation pressure for this trauma,which can improve hemodynamics, decrease cerebral edema and increase survival rate.