Department of Anaesthesia and Intensive Care, Lund University Hospital and Skane University Hospital, Lund, Sweden.
Crit Care Med. 2011 Jan;39(1):135-40. doi: 10.1097/CCM.0b013e3181fb7c94.
To compare the intracranial pressure after resuscitation to normovolemia by using 20% albumin or normal saline in a cat model of meningitis.
Prospective, randomized animal study.
University hospital laboratory.
Twenty adult, male cats.
Meningitis was induced by intrathecal injection of Escherichia coli-derived lipopolysaccharide (0.8 × 10 units/kg). Four hours after the lipopolysaccharide injection, the animals were randomized to intravenous treatment with 0.4 mL/kg/hr of 20% albumin or 7.5 mL/kg/hr of 0.9% sodium chloride for 6 hrs (n = 7 per group). A control group receiving lipopolysaccharide but no fluid was also studied (n = 6).
Effects on intracranial pressure, mean arterial pressure, plasma volume (I-albumin technique), plasma oncotic pressure, and brain metabolism via cerebral interstitial lactate/pyruvate ratio and glycerol and glucose levels (microdialysis technique) were evaluated. Plasma volume decreased by approximately 20% and intracranial pressure increased from 10 to approximately 20 mm Hg at 4 hrs after the lipopolysaccharide injection. Six hours later, plasma volume had returned to baseline in both fluid groups while there was a further reduction in the control group. Intracranial pressure was higher in the saline group than in the albumin and control groups and was 25.8 ± 2.8 mm Hg, 18.3 ± 0.6 mm Hg, and 20.4 ± 1.7 mm Hg, respectively. Plasma oncotic pressure was higher in the albumin group than in the saline and control groups. Mean arterial pressure and microdialysis data were within normal range and did not differ among the groups.
The results showed that the choice of resuscitation fluid may influence intracranial pressure in meningitis. The lower intracranial pressure in the colloid group may be explained by a higher plasma oncotic pressure and less fluid distribution to the brain interstitium.
比较猫细菌性脑膜炎模型中复苏至正常血容量时应用 20%白蛋白或生理盐水对颅内压的影响。
前瞻性、随机动物研究。
大学医院实验室。
20 只成年雄性猫。
鞘内注射大肠杆菌来源的脂多糖（0.8×10 单位/kg）诱导细菌性脑膜炎。脂多糖注射后 4 小时，动物随机接受静脉内 0.4ml/kg/hr 的 20%白蛋白或 7.5ml/kg/hr 的 0.9%氯化钠治疗 6 小时（每组 7 只）。还研究了接受脂多糖但不接受液体治疗的对照组（n=6）。
评估颅内压、平均动脉压、血浆容量（I-白蛋白技术）、血浆胶体渗透压以及通过脑间质乳酸/丙酮酸比和甘油及葡萄糖水平（微透析技术）评估脑代谢的影响。脂多糖注射后 4 小时，血浆容量下降约 20%，颅内压从 10mmHg 升高至约 20mmHg。6 小时后，在两个液体组中，血浆容量已恢复至基线，而在对照组中则进一步下降。生理盐水组的颅内压高于白蛋白组和对照组，分别为 25.8±2.8mmHg、18.3±0.6mmHg 和 20.4±1.7mmHg。白蛋白组的血浆胶体渗透压高于生理盐水组和对照组。平均动脉压和微透析数据均在正常范围内，各组间无差异。
结果表明，复苏液的选择可能影响脑膜炎时的颅内压。胶体组的颅内压较低可能是由于血浆胶体渗透压较高和较少的液体分布到脑间质。
