Gurevich B, Talmor D, Artru A A, Katcko L, Geva D, Gurman G, Shapira Y
Department of Anesthesiology, Kaplan Hospital, Beer-Sheva, Israel.
Anesth Analg. 1997 Mar;84(3):554-9. doi: 10.1097/00000539-199703000-00016.
We previously reported that in rats with closed head trauma (CHT), intravenous (IV) administration of 0.25 mL/g of 5% dextrose solution (D5W) increased blood glucose (G), decreased blood sodium (Na), caused no change in blood osmolality (Osm), increased brain edema (BE), and worsened neurological severity score (NSS) and mortality rate (MR). D5W in 0.9% saline (D5NS) is isonatremic and hyperosmolar with respect to blood and may avoid the problems reported with D5W. The present study compared the effects of 0.25 mL/g of D5NS or 0.45% saline (0.45 S) after CHT in rats. In 11 groups of rats, the three experimental variables were CHT (yes or no), IV fluid (none, D5NS, or 0.45 S), and time of death (4 or 24 h). D5NS or 0.45 S was given IV at 1 h after surgical preparation with or without CHT, and experimental values were determined at 1, 2, 4, and 24 h. D5NS decreased BE at 4 h compared with the untreated group, increased Osm (380 +/- 2 mOsm/kg) and G (1278 +/- 199 mg/dL), decreased Na (131 +/- 2 mEq/L) in blood, and caused no significant change in hemorrhagic necrosis volume (HNV), NSS, or MR. 0.45 S increased MR (50%) at 24 h, decreased Osm (270 +/- 5 mOsm/kg) and Na (123 +/- 1 mEq/L) in blood, and caused no significant change in G, BE, HNV, or NSS. We conclude that after CHT in rats, D5NS decreased BE without changing NSS or MR. 0.45 S increased MR and significantly altered blood chemistries.
我们之前报道过，在闭合性颅脑损伤（CHT）大鼠中，静脉注射（IV）0.25 mL/g的5%葡萄糖溶液（D5W）会使血糖（G）升高、血钠（Na）降低、血渗透压（Osm）无变化、脑水肿（BE）加重，并且神经严重程度评分（NSS）和死亡率（MR）恶化。相对于血液，0.9%生理盐水（D5NS）中的D5W是等钠且高渗的，可能避免D5W所报告的问题。本研究比较了CHT大鼠静脉注射0.25 mL/g的D5NS或0.45%生理盐水（0.45 S）后的效果。在11组大鼠中，三个实验变量分别是CHT（有或无）、静脉输液（无、D5NS或0.45 S）以及死亡时间（4小时或24小时）。在有或无CHT的手术准备后1小时静脉注射D5NS或0.45 S，并在1、2、4和24小时测定实验值。与未治疗组相比，D5NS在4小时时可降低BE，使血液中的Osm升高（380±2 mOsm/kg）、G升高（1278±199 mg/dL）、Na降低（131±2 mEq/L），并且出血性坏死体积（HNV）、NSS或MR无显著变化。0.45 S在24小时时使MR升高（50%），使血液中的Osm降低（270±5 mOsm/kg）、Na降低（123±1 mEq/L），并且G、BE、HNV或NSS无显著变化。我们得出结论，在大鼠CHT后，D5NS可降低BE而不改变NSS或MR。0.45 S可升高MR并显著改变血液化学成分。
