Poole G V, Prough D S, Johnson J C, Stullken E H, Stump D A, Howard G
J Trauma. 1987 Jan;27(1):18-23. doi: 10.1097/00005373-198701000-00004.
This study compares intracranial pressure, cerebral blood flow, and cerebral oxygen transport during hemorrhagic shock and following fluid resuscitation with crystalloid or colloid solution in a canine model with an epidural mass lesion. After placement of an epidural balloon, intracranial pressure was increased to 30 mm Hg for 5 minutes and then permitted to vary without further manipulation. Hemorrhagic shock was produced by the rapid removal of blood to achieve a mean arterial pressure of 55 mm Hg for 30 minutes. Resuscitation then was performed with intravenous lactated Ringer's solution, 60 ml/kg, or with 6.0% hetastarch, 20 ml/kg. Following both solutions mean arterial pressure and cardiac output were increased and hemoglobin concentration was reduced. Intracranial pressure was significantly lower immediately after resuscitation in the hetastarch group; it then gradually increased so that the difference was much less 1 hour later. Cerebral blood flow decreased during shock and was not restored by either fluid; cerebral oxygen transport fell further with resuscitation in both groups due to hemodilutional reductions in hemoglobin. Although colloid resuscitation improved systemic hemodynamics and maintained lower intracranial pressure, it failed, as did crystalloid resuscitation, to restore cerebral oxygen transport to prehemorrhagic shock levels.
本研究在一个伴有硬膜外占位性病变的犬类模型中，比较了失血性休克期间以及用晶体液或胶体液进行液体复苏后颅内压、脑血流量和脑氧输送情况。放置硬膜外球囊后，将颅内压升高至30 mmHg并维持5分钟，然后任其变化而不再进一步干预。通过快速放血使平均动脉压达到55 mmHg并维持30分钟，从而造成失血性休克。然后分别用60 ml/kg的静脉注射乳酸林格液或20 ml/kg的6.0%羟乙基淀粉进行复苏。两种溶液输注后，平均动脉压和心输出量均增加，血红蛋白浓度降低。羟乙基淀粉组复苏后即刻颅内压显著降低；随后逐渐升高，以至于1小时后差异明显减小。休克期间脑血流量减少，两种液体均未能使其恢复；由于血红蛋白因血液稀释而降低，两组复苏后脑氧输送均进一步下降。尽管胶体液复苏改善了全身血流动力学并维持了较低的颅内压，但它与晶体液复苏一样，未能将脑氧输送恢复到失血性休克前的水平。
