高渗醋酸钠右旋醣酐与多巴胺伍用对初进高原失血性休克合并肺水肿大鼠的治疗作用

Therapeutic effect of hypertonic sodium acetate dextran combined with dopamine on hemorrhagic shock with pulmonary edema in rats first entering high altitude

目的 探讨高渗醋酸钠右旋醣酐 (HAD)与多巴胺 (DA)伍用对初进高原大鼠失血性休克伴肺水肿的治疗效果。 方法 初进高原 (西藏拉萨 )SD大鼠 4 2只 ,戊巴比妥钠 (30mg kg)腹腔注射麻醉 ,维持血压在 5 0mmHg ,同时加油酸 (5 μl 10 0g)静脉注射维持 1h复制失血性休克合并肺水肿模型。实验分为正常对照组 (不放血、不给油酸 )、休克合并肺水肿对照组、乳酸林格液(4ml kg ,LR)对照组、HAD(4ml kg)单用组、DA(2mg kg)单用组和HAD +DA组 ,每组 7只大鼠。观察给药后 15 ,30 ,6 0和 12 0min时血流动力学指标的变化 ,给药后 30和 12 0min时血气指标的变化和 12 0min时肺、脑含水量的变化。 结果 与LR对照组比较 ,HAD和DA单用可显著升高休克合并肺水肿大鼠平均动脉压 (MAP)、左心室收缩压 (LVSP)和左室内压最大变化速率 (±dp dtmax)等指标 (P <0 .0 5和 0 .0 1) ,改善部分血气指标如血氧饱和度和降低肺、脑含水量。二者伍用时其升高MAP、LVSP和±dp dtmax的作用和降低肺、脑含水量的作用效果显著优于两者单用 (P <0 .0 5和0 .0 1)。 结论 HAD与DA伍用可较好地改善高原失血性休克合并肺水肿大鼠血流动力学指标和血气指标 ,并减轻肺水肿 ,二者伍用优于单用效果 ;二者联合用药可用于高原休克的早期救治。

Objective To study the therapeutic effects of hypertonic sodium acetate dextran (HAD) in combination with dopamine (DA) on hemorrhagic shock complicated by pulmonary edema in the rats first entering high altitude. Methods Forty-two SD rats, first transported to Lhasa, Tibet (3 760 meters above the sea level), were anesthetized with sodium pentobarbital (30 mg/kg, ip). Hemorrhagic shock model with pulmonary edema was induced by hemorrhage (blood pressure at 50 mm Hg) plus intravenous injection of oleic acid (5 _l/100 g) for 1 hour. All the rats were equally divided into 6 groups, ie, normal control (no hemorrhage or oleic acid), hemorrhagic shock with pulmonary edema (HSPE), HSPE plus lactated Ringer's solution (LR, 4 ml/kg), HAD (4 ml/kg) alone, DA (2 mg/kg) alone and the combined use of HAD and DA groups. After drug administration, the hemodynamic parameters including mean arterial blood pressure (MAP), left intraventricular systolic pressure (LVSP) and the changes of intraventricular pressure (±dp/dt max) were observed at the 15th, 30th, 60th and 120th minutes respectively, blood gases at the 30th and 120th minutes respectively and the water content of the lung and the brain at the 120th minutes. Results As compared with LR control group, HAD (4 ml/kg) or DA (2 mg/kg) used alone significantly increased MAP, LVSP and ±dp/dt max ( P <0.05 and 0.01), improved partial variables like blood gases and decreased the water content of the lung and the brain. HAD and DA used together could better improve the hemodynamic parameters and decrease the water content of the lung and the brain than those used alone ( P <0.05 and 0.01). Conclusions HAD in combination with DA can apparently improve the hemodynamic parameters and the blood gases and alleviate pulmonary edema of rats with hemorrhagic shock complicated by pulmonary edema. The combination usage of HAD and DA is superior to that used alone and can be used as an alternative for the early cure of high altitude shock.