目的探讨高渗盐复合液（高渗盐水羟乙基淀粉HSH）在颅脑损伤合并低血容量性休克中的疗效及对颅内压（ICP）的影响。方法为前瞻、对照性研究。选择2007年9月至2008年7月入住广东省人民医院ICU及脑外科颅脑损伤且平均动脉压（MAP）低于60m...目的探讨高渗盐复合液（高渗盐水羟乙基淀粉HSH）在颅脑损伤合并低血容量性休克中的疗效及对颅内压（ICP）的影响。方法为前瞻、对照性研究。选择2007年9月至2008年7月入住广东省人民医院ICU及脑外科颅脑损伤且平均动脉压（MAP）低于60mmHg的患者60例，其中男51例，女9例，年龄18～69岁，平均（41．5±9．5）岁。排除标准：年龄〈18岁或〉70岁的患者；孕妇、月经期妇女；严重肝肾功能障碍；高血压、冠心病、糖尿病病史者；大出血未止住；治疗前数小时内应用过其它血管活性物质；受伤超过24h者；脑死亡。随机分成3组（每组20例），3组年龄性别构成具可比性，分别以平衡液（平衡液LR组）500ml、5％氯化钠（高渗盐水HIS组）4ml／kg、HSH（HSH组）4ml／kg进行液体复苏，记录复苏前及复苏30、60、120min时的血压、呼吸、心率、尿量等，抽静脉血检测凝血功能、电解质，应用颅内压无创检测分析仪测量ICP。采用SPSS13．0统计软件进行统计学处理数据，各组复苏前后指标应用重复测量设计资料的方差检验分析，组间比较应用（one—way analysis of variance ANOVA）检验分析，以P〈0．05为差异有统计学意义。结果复苏30min时HIS、HSH组MAP即恢复到60mmHg以上，且ICP降低10％以上；60min时LR组MAP恢复到60mmHg以上，但ICP无降低。120min时HSH提高MAP和降低ICP的作用优于LR、HIS组，差异有统计学意义（F=18．43，8．99，P〈0．05）；各组用药前后实验室检测指标无明显变化（P〉0．05）。结论在颅脑损伤合并低血容量性休克的救治中HSH复苏效果及降低颅内压作用显著且持久，有利于保护脑功能。展开更多
Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and...Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and hydroxyethyl starch （HES）. Methods： BALB/c mice were randomly divided into control, NS, HTS, and HES resuscitation groups. Three subgroups （n=8） in each resuscitation group were marked as 2, 24, and 72 h. Flow cytometry was used to detect the MDSCs, monocytic MDSCs （M-MDSCs）, and granulocytic/neutrophilic MDSCs （G-MDSCs） in peripheral blood nucleated cells （PBNCs）, spleen single-cell suspension, and bone marrow nucleated cells （BMNCs）. Results： The MDSCs in BMNCs among three resuscitation groups were lower 2 h after shock, in PBNCs of the HTS group were higher, and in spleen of the NS group were lower （all P〈0.05 vs. control）. The M-MDSC/G-MDSC ratios in PBNCs of the HTS and HES groups were lower （both ,P〈0.05 vs. control）. At 24 h, the MDSCs in PBNCs of the NS and HTS groups were higher, while the spleen MDSCs in the HTS group were higher （all P〈0.05 vs. control）. The M-MDSC/ G-MDSC ratios were all less in PBNCs, spleen, and BMNCs of the NS and HTS groups, and were lower in BMNCs of the HES group （all P〈0.05 vs. control）. At 72 h, the elevated MDSCs in PBNCs were presented in the HTS and HES groups, and in spleen the augment turned up in three resuscitation groups （all P〈0.05 vs. control）. The inclined ratios to M-MDSC were exhibited in spleen of the NS and HTS groups, and in PBNCs of the NS group; the inclination to G-MDSC in BMNCs was shown in the HES group （all P〈0.05 vs. control）. Conclusions： HTS induces the earlier ele- vation of MDSCs in peripheral blood and spleen, and influences its distribution and differentiation, while HES has a less effect on the distribution but a stronger impact on the differentiation of MDSCs, especially in bone marrow.展开更多
文摘目的探讨高渗盐复合液（高渗盐水羟乙基淀粉HSH）在颅脑损伤合并低血容量性休克中的疗效及对颅内压（ICP）的影响。方法为前瞻、对照性研究。选择2007年9月至2008年7月入住广东省人民医院ICU及脑外科颅脑损伤且平均动脉压（MAP）低于60mmHg的患者60例，其中男51例，女9例，年龄18～69岁，平均（41．5±9．5）岁。排除标准：年龄〈18岁或〉70岁的患者；孕妇、月经期妇女；严重肝肾功能障碍；高血压、冠心病、糖尿病病史者；大出血未止住；治疗前数小时内应用过其它血管活性物质；受伤超过24h者；脑死亡。随机分成3组（每组20例），3组年龄性别构成具可比性，分别以平衡液（平衡液LR组）500ml、5％氯化钠（高渗盐水HIS组）4ml／kg、HSH（HSH组）4ml／kg进行液体复苏，记录复苏前及复苏30、60、120min时的血压、呼吸、心率、尿量等，抽静脉血检测凝血功能、电解质，应用颅内压无创检测分析仪测量ICP。采用SPSS13．0统计软件进行统计学处理数据，各组复苏前后指标应用重复测量设计资料的方差检验分析，组间比较应用（one—way analysis of variance ANOVA）检验分析，以P〈0．05为差异有统计学意义。结果复苏30min时HIS、HSH组MAP即恢复到60mmHg以上，且ICP降低10％以上；60min时LR组MAP恢复到60mmHg以上，但ICP无降低。120min时HSH提高MAP和降低ICP的作用优于LR、HIS组，差异有统计学意义（F=18．43，8．99，P〈0．05）；各组用药前后实验室检测指标无明显变化（P〉0．05）。结论在颅脑损伤合并低血容量性休克的救治中HSH复苏效果及降低颅内压作用显著且持久，有利于保护脑功能。
基金Project supported by the National Natural Science Foundation of China(No.81272075)
文摘Objective： To investigate the distribution and differentiation of myeloid-derived suppressor cells （MDSCs） in hemorrhagic shock mice, which are resuscitated with normal saline （NS）, hypertonic saline （HTS）, and hydroxyethyl starch （HES）. Methods： BALB/c mice were randomly divided into control, NS, HTS, and HES resuscitation groups. Three subgroups （n=8） in each resuscitation group were marked as 2, 24, and 72 h. Flow cytometry was used to detect the MDSCs, monocytic MDSCs （M-MDSCs）, and granulocytic/neutrophilic MDSCs （G-MDSCs） in peripheral blood nucleated cells （PBNCs）, spleen single-cell suspension, and bone marrow nucleated cells （BMNCs）. Results： The MDSCs in BMNCs among three resuscitation groups were lower 2 h after shock, in PBNCs of the HTS group were higher, and in spleen of the NS group were lower （all P〈0.05 vs. control）. The M-MDSC/G-MDSC ratios in PBNCs of the HTS and HES groups were lower （both ,P〈0.05 vs. control）. At 24 h, the MDSCs in PBNCs of the NS and HTS groups were higher, while the spleen MDSCs in the HTS group were higher （all P〈0.05 vs. control）. The M-MDSC/ G-MDSC ratios were all less in PBNCs, spleen, and BMNCs of the NS and HTS groups, and were lower in BMNCs of the HES group （all P〈0.05 vs. control）. At 72 h, the elevated MDSCs in PBNCs were presented in the HTS and HES groups, and in spleen the augment turned up in three resuscitation groups （all P〈0.05 vs. control）. The inclined ratios to M-MDSC were exhibited in spleen of the NS and HTS groups, and in PBNCs of the NS group; the inclination to G-MDSC in BMNCs was shown in the HES group （all P〈0.05 vs. control）. Conclusions： HTS induces the earlier ele- vation of MDSCs in peripheral blood and spleen, and influences its distribution and differentiation, while HES has a less effect on the distribution but a stronger impact on the differentiation of MDSCs, especially in bone marrow.
