Xiao Hua-ping, Gu Miao-ning, Xiao Jin-fang, Xu Xiang, Zhao Zhen-long
Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2008 Mar;28(3):385-8.
To observe the effect of hypertonic sodium chloride hydroxyethyl starch 40 injection (HSH) in treatment of acute intracranial hypertension complicated by hemorrhagic shock in dogs, and explore the mechanism of the effects of HSH.
Twenty dogs were randomized into 4 equal groups, namely the 7.5% NaCl (HS) group, Ringer-Lactates solution (RL) group, hydroxyethyl strarch (HES) group, and HSH group. Canine models of acute intracranial hypertension complicated by hemorrhagic shock were established by epidural balloon inflation with saline and rapid discharge of the arterial blood. One hour after the induced shock, the dogs were given HS (6 ml/kg), RL of 3-fold volume of blood loss, HES of equivalent volume of blood loss, and HSH 8 ml/kg in the 4 groups, respectively. During the shock and resuscitationperiod, the intracranial pressure (ICP), mean arterial pressure (MAP) and cerebral perfusion pressure (CPP) of the dogs were monitored, and the serum sodium level and plasma osmolality were measured at 30 min, 1 h and 4 h after the resuscitation.
All dogs had similar MAP, CPP, and ICP before resuscitation (P>0.05). After resuscitation, the MAP was significantly improved (P<0.01), but the dogs in HSH group exhibited the fastest response; with the exception of the dogs in HS group to have significantly decreased MAP 2 h after resuscitation (P<0.01), all the other dogs maintained the MAP for 4 h. The CPP was also significantly increased after resuscitation (P<0.01), and in HS group, CPP decreased significantly after 2 h (P<0.01), and HSH group maintained the high CPP after 4 h. The ICP was increased significantly in RL and HES groups after resuscitation (P<0.01), reaching the peak level at 1 and 3 h, respectively, but in HS and HSH groups, the ICP decreased significantly to the lowest level at 1 h (P<0.01) which was maintained for 4 h. After resuscitation, the plasma sodium and plasma osmolality were significantly increased in HSH and HS groups.
In dogs with acute intracranial hypertension and hemorrhagic shock, HSH can effectively resuscitate hemorrhagic shock and decrease ICP, and the effect is longer-lasting than that of HS.
观察高渗氯化钠羟乙基淀粉40注射液（HSH）对犬急性颅内高压合并失血性休克的治疗效果，并探讨其作用机制。
将20只犬随机分为4组，每组5只，即7.5%氯化钠（HS）组、乳酸林格液（RL）组、羟乙基淀粉（HES）组和HSH组。采用硬膜外气囊注入生理盐水及快速放血的方法建立犬急性颅内高压合并失血性休克模型。休克诱导1小时后，4组犬分别给予HS（6 ml/kg）、失血量3倍体积的RL、等量失血量的HES及8 ml/kg的HSH。在休克及复苏期间，监测犬的颅内压（ICP）、平均动脉压（MAP）和脑灌注压（CPP），并在复苏后30分钟、1小时和4小时测定血清钠水平和血浆渗透压。
复苏前各组犬的MAP、CPP和ICP相似（P>0.05）。复苏后，MAP显著改善（P<0.01），但HSH组犬的反应最快；除HS组犬复苏后2小时MAP显著下降（P<0.01）外，其他组犬的MAP均维持4小时。复苏后CPP也显著升高（P<0.01），HS组CPP在2小时后显著下降（P<0.01），HSH组4小时后仍维持较高的CPP。复苏后，RL组和HES组的ICP显著升高（P<0.01），分别在1小时和3小时达到峰值水平，但HS组和HSH组的ICP在1小时时显著下降至最低水平（P<0.01）并维持4小时。复苏后，HSH组和HS组的血浆钠和血浆渗透压显著升高。
对于急性颅内高压合并失血性休克的犬，HSH能有效复苏失血性休克并降低ICP，且效果比HS更持久。
