不同液体复苏策略在重型颅脑损伤合并失血性休克大鼠中的应用效果

Application effect of different fluid resuscitation strategies in rats with severe craniocerebral injury combined with hemorrhagic shock

目的探讨不同液体复苏策略在重型颅脑损伤合并失血性休克大鼠中的应用效果。方法将100只实验大鼠按随机数字表法分为Ⅰ组、Ⅱ组、Ⅲ组、Ⅳ组,每组25只。Ⅰ组采用10%高渗氯化钠注射液以80 mmHg目标进行液体复苏,Ⅱ组采用10%高渗氯化钠注射液以60 mmHg目标进行液体复苏,Ⅲ组采用7.5%高渗氯化钠注射液以80 mmHg目标进行液体复苏,Ⅳ组采用7.5%高渗氯化钠注射液以60 mmHg目标进行液体复苏,各组应用不同浓度值的高渗氯化钠注射液经颈静脉缓慢注射直至复苏目标值,测量造模前后及复苏后的平均动脉压及脑灌注压,比较各组造模前(T_(0))、造模后(T_(1))、复苏后20 min(T_(2))、复苏后40 min(T_(3))、复苏后1 h(T_(4))、复苏后2 h(T_(5))、复苏后3 h(T_(6))、复苏后4 h(T_(7))的中心静脉压(CVP)、颅内压(ICP)、平均动脉压(MAP)、脑灌注压(CPP)、动脉血钠离子浓度、血浆渗透压、大鼠脑组织含水量。结果Ⅳ组T_(7)时的MAP水平均高于其余三组,差异有统计学意义(P<0.05);四组T_(1)~T_(6)时的MAP水平比较,差异无统计学意义(P>0.05);各组T_(0)时段的动脉血钠离子浓度比较,差异无统计学意义(P>0.05);Ⅳ组T_(7)时的动脉血钠离子浓度低于其他三组,差异有统计学意义(P<0.05)。各组不同时间点的渗透压比较,差异无统计学意义(P>0.05);Ⅰ、Ⅱ、Ⅲ组伤侧半球T_(1)时的脑组织含水量均高于健侧半球,差异有统计学意义(P<0.05);Ⅳ组T_(7)时的脑组织水含量均低于其他三组,差异有统计学意义(P<0.05)。结论重型脑损伤合并失血性休克应用小容量的液体复苏治疗能更好地恢复大鼠脑组织循环血容量,有较好的神经功能改善作用。

Objective To explore the application effect of different fluid resuscitation strategies in rats with severe craniocerebral injury combined with hemorrhagic shock.Methods A total of 100 experimental rats were randomly divided into GroupⅠ,GroupⅡ,GroupⅢand GroupⅣaccording to random number table method,with 25 cases in each groups.GroupⅠwas given 10%hypertonic sodium chloride injection for liquid resuscitation with a target of 80 mmHg,GroupⅡwas given 10%hypertonic sodium chloride injection for liquid resuscitation with a target of 60 mmHg,and GroupⅢwas given 7.5%hypertonic sodium chloride injection with a target of 80 mmHg for liquid resuscitation,GroupⅣwas treated with 7.5%hypertonic sodium chloride injection and liquid resuscitation with 60 mmHg target.Each group was treated with hypertonic sodium chloride injection with different concentration values through jugular vein slowly until the target value of resuscitation.The mean arterial pressure and cerebral perfusion pressure before and after model establishment and resuscitation were measured,and the indexes of central venous pressure(CVP),intracranial pressure(ICP),mean arterial pressure(MAP),cerebral perfusion pressure(CPP),arterial blood sodium concentration,plasma osmotic pressure,and brain tissue water content of rats before model establishment(T_(0)),after model establishment(T_(1)),20 minutes after resuscitation(T_(2)),40 minutes after resuscitation(T_(3)),1 hour after resuscitation(T_(4)),2 hours after resuscitation(T_(5)),3 hours after resuscitation(T_(6)),and 4 hours after resuscitation(T_(7))were compared.Results The level of MAP in groupⅣat T_(7) were higher than those in the other three groups,and the differences were statistically significant(P<0.05).There were no significant differences in the level of MAP among the four groups at T_(1)-T_(6)(P>0.05);There were no statistically significant differences in the concentration of arterial blood sodium at T_(0) in each group(P>0.05).The concentration of arterial blood sodium at T_(7) in groupⅣwere significantly lower than those in the other three groups(P<0.05).There were no statistically significant difference in the osmotic pressure between the each groups in each period(P>0.05).The water content of brain tissue in the injured hemisphere of groupⅠ,ⅡandⅢwere higher than those in the healthy hemisphere at T_(1),with statistically significant differences(P<0.05).The water content of brain tissue in groupⅣat T_(7) were lower than those in the other three groups,with statistically significant differences(P<0.05).Conclusion The treatment of severe brain injury combined with hemorrhagic shock with small volume fluid resuscitation can better restore the circulating blood volume of brain tissue in rats,and has a better effect on improving neural function.