[摘要] 目的 观察高渗氯化钠羟乙基淀粉40注射液(HSH)在犬急性颅内高压伴失血性休克模型中恢复循环血容量、减轻脑组织水肿和降低脑组织氧自由基含量的作用。方法 健康杂种犬20只，采用硬膜外球囊注水和动脉放血的方法复制急性颅内高压伴失血性休克模型。动物随机分为羟乙基淀粉溶液组（HES组），乳酸林格氏液组（RL组），7.5%氯化钠溶液组（HS组）和高渗氯化钠羟乙基淀粉40注射液组（HSH组），在休克后1h分别输入相应液体。监测平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、颅内压（ICP），检测脑组织丙二醛（MDA）含量、超氧化物歧化酶（SOD）活力，脑组织标本行病理学检查。结果 复苏后4组液体均能有效升高MAP（P＜0.05），但HES组和RL组的ICP上升明显（P＜0.05），复苏后2h，HS组的MAP开始下降（P＜0.05）。至复苏后4h，仅HSH组能维持理想的MAP及较低的ICP，HSH组脑组织氧自由基含量较其他组明显减少（P＜0.05）。病理学检查显示复苏后4h，HSH组的脑组织损伤较其他组轻。结论 高渗氯化钠羟乙基淀粉40注射液可有效复苏失血性休克，降低ICP及氧自由基的生成，减轻脑组织缺血再灌注的损伤。

[关键词] 高渗氯化钠羟乙基淀粉40注射液 犬 急性颅内高压 失血性休克 颅内压 脑组织 超氧化物歧化酶 丙二醛

Effect of HSH on oxygen free radicals and histopathological change of brain tissue in acute intracranial hypertension and hemorrhagic shock model of dog
XU Xiang , GU Miao-ning , XIAO Jin-fang , XIAO Hua-ping , ZHAO Zhen-long , LIU Gao-wang . Department of Anesthesiology Nan Fang Hospital ,Nan Fang Medicai college ,Guang Zhou ,510515,China.

[Abstract] Objective To observe the effect of hypertonic sodium chloride hydroxyethyl starch 40 injection（HSH） on oxygen free radicals and morphological change of brain tissue in acute intracranial hypertension and hemorrhagic shock model of dog. Methods 20 healthy dogs were randomly divided into group HES,group RL,group HS and group HSH. Balloon epidural injection and arterial bleeding model was prepared.Corresbonding liquids were infused sepa免费论文网 【http://www.51lunwen.net】rately 1h after shock.The level of mean arterial blood pressure(MAP),central venous pressure(CVP),heart rate(HR) and intracranial pressure(ICP) were monitored,and the level of superoxide dismutase(SOD) and malondialdehyde(MDA) were determined.Samples of brain tissue were removed for Pathological examination. Results After resuscitation, liquids of 4 groups can effectively increase MAP(P＜0.05）, but group HES and group RL significantly increased ICP(P＜0.05）. 2 hours after resuscitation, MAP of group HS begin to decrease and 4 hours after resuscitation only group HSH can maintain a ideal MAP and lower ICP. MDA and SOD levels were statistically significant different between group HSH and other groups 4 hours after resuscitation (P＜0.05）. Pathological examination revealed less injury in group HSH. Conclusion HSH can effectively resuscite hemorrhagic shock,decrese ICP, reduce oxygen free radicals levels in brain and relieve tissue ischemia/reperfusion injury.

[Key Words]HSH;dog;acute intracranial hypertension; hemorrhagic shock;brain tissue; SOD;MDA.

颅脑外伤是最严重的创伤之一，而合并失血性休克的重度脑外伤死亡率极高（1）。控制脑组织水肿、减少脑细胞损伤是神经外科围手术期治疗的重要手段，也是决定患者预后的关键因素。休克时常输注大量液体以维持血压稳定，却往往造成脑组织水肿，引起继发性损伤；缺血再灌注时产生大量的氧自由基，常造成脑细胞的不可逆损害；而常规应用脱水利尿药治疗脑水肿降低颅内压（intracranial pressure,ICP）时，又会减少有效血容量，加重休克。本实验主要观察高渗氯化钠羟乙基淀粉40注射液（hypertonic sodium chloride hydroxyethyl starch 40 injection，HSH）复苏失血性休克降低颅内压作用，通过检测脑组织丙二醛（MDA）含量、超氧化物歧化酶（SOD）活力，就HSH对脑组织缺血－再灌注损伤主要环节的 本文来自：免费论文网 [http://www.51lunwen.net]