3%氯化钠输液速度对重型颅脑损伤大鼠颅内压的影响

Effects of infusion of 3% hypertonic saline with different rates on intracranial pressure in brain-injured rats

目的探讨重型颅脑损伤造模大鼠输注3%氯化钠溶液降低颅内压的合适输液速度。方法将51只雄性Wistar大鼠随机分为对照组、快输组和慢输组各17只。重型颅脑损伤造模成功后对快输组和慢输组采用微量输液泵各输入3%氯化钠溶液6mL,快输组1h匀速输完,慢输组3h匀速输完;给药过程中持续监测颅内压,给药完成后观察颅内压降至最低即处死大鼠,对照组不输液,同时间处死。取血测血清电解质、C反应蛋白(CRP),取脑组织测脑组织含水量以及水通道蛋白-4(AQP-4),取肺组织测湿/干重比值。结果给药全程快输组与慢输组颅内压差异无统计学意义(P>0.05),快输组降颅内压起效时间显著快于慢输组(P<0.01),较慢输组更能有效下调脑组织AQP-4(P<0.05)。给药结束后快输组与慢输组血钠及血氯水平显著上升(均P<0.01);两组血CRP显著低于对照组(均P<0.05)。结论对重型颅脑损伤造模大鼠快输和慢输3%氯化钠溶液均能有效降低颅内压,快输组起效时间更快、减轻脑水肿的作用更为显著。

Objective To investigate an optimal infusion rate of 3% hypertonic saline to reduce intracranial pressure （ICP） in rats with severe traumatic brain injury （TBI）. Methods Fifty one male Wistar rats were randomly divided into three groups, with 17 in each group. After successful induction of TBI, rats in the control group did not receive infusion and were sacrificed after the study, while the two infusion groups received 6 mL of 3G hypertonic saline, with the rate being 6 mL/h for the bolus infusion group and 2 mL/h for the slow infusion group using pump to control the infusion rate. ICP was monitored during the whole infusion duration and rats were sacrificed when the ICP dropped to the lowest. Blood samples were collected to detect concentrations of serum elec trolytes and C-reaction protein （CRP）, brain tissue was harvested to detect brain water content and the aquaporin 4 （AQP 4） ex- pression, and lung tissue was harvested to test wet/dry ratio （W/D ratio）. Results There was no significant difference in ICP be tween the two infusion groups during the whole infusion duration （P〉0.05）. Comparing to the slow infusion group, the bolus in fusion group had a faster onset time of action （P〈0.01） and a stronger effect on downregulation of AQP 4 （P〈0.05）. Serum so dium and chloride in the two infusion groups were significantly increased after administration of hypertonic saline （P〈0.01 for all）, and CRP levels of the two infusion groups were significantly lower than the control group （P〈0.05 for both）. Conclusion In fusion of 3% hypertonic saline can effectively reduce ICP in rats after TBI, and bolus infusion has a faster onset time of action and a more significant effect on relief of cerebral edema.