Heimann A, Takeshima T, Alessandri B, Noppens R, Kempski O
Institute for Neurosurgical Pathophysiology, Johannes Gutenberg-University Mainz, Germany.
Crit Care Med. 2003 Oct;31(10):2495-501. doi: 10.1097/01.CCM.0000084893.44650.CB.
To examine the effects of hypertonic/hyperoncotic treatment on physiologic variables and regional cerebral blood flow and to test its neuroprotective efficiency in a model of permanent venous ischemia.
Randomized prospective study.
University research institute.
Adult male Wistar rats, weighing 359 +/- 54 g (n = 38).
Rats were subjected to photochemical occlusion of two adjacent cortical veins. A randomized infusion with vehicle (0.9% NaCl), 10% hydroxyethyl starch 200,000 (HES), or 7.5% saline plus 10% hydroxyethyl starch 200,000 (HHES) was started 30 mins after two-vein occlusion. Effects on physiologic variables and regional cerebral blood flow (assessed by laser Doppler flowmetry) were studied up to 120 mins after two-vein occlusion. Two days after occlusion, the brains were removed for histologic evaluation.
After occlusion, regional cerebral blood flow decreased by 50%, significantly in all groups (from 47.3 +/- 3 to 22.2 +/- 2.2 laser Doppler units). In the vehicle and HES groups, regional cerebral blood flow further decreased to 12.9 +/- 1.9 and 17.8 +/- 2.3 laser Doppler units, respectively. HHES improved regional cerebral blood flow significantly to 27.3 +/- 3.5 laser Doppler units, particularly by reducing no-flow/low-flow areas and reducing infarct size.
We found that HHES reduced infarct size as a consequence of an improved regional cerebral blood flow and reduced no-flow/low-flow areas in the tissue at risk in the two-vein occlusion model.
研究高渗/高渗胶体治疗对生理变量和局部脑血流的影响,并在永久性静脉缺血模型中测试其神经保护效果。
随机前瞻性研究。
大学研究机构。
成年雄性Wistar大鼠,体重359±54克(n = 38)。
对大鼠两条相邻皮质静脉进行光化学闭塞。在两条静脉闭塞30分钟后,随机输注溶媒(0.9%氯化钠)、10%万汶(羟乙基淀粉200000)或7.5%盐水加10%万汶(羟乙基淀粉200000)。在两条静脉闭塞后长达120分钟内,研究对生理变量和局部脑血流(通过激光多普勒血流仪评估)的影响。闭塞两天后,取出大脑进行组织学评估。
闭塞后,局部脑血流下降50%,所有组均显著下降(从47.3±3降至22.2±2.2激光多普勒单位)。在溶媒组和万汶组中,局部脑血流进一步分别降至12.9±1.9和17.8±2.3激光多普勒单位。高渗盐水加万汶组显著改善局部脑血流至27.3±3.5激光多普勒单位,尤其是通过减少无血流/低血流区域和缩小梗死面积。
我们发现,在双静脉闭塞模型中,高渗盐水加万汶组由于改善了局部脑血流并减少了危险组织中的无血流/低血流区域,从而缩小了梗死面积。