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目的:比较3种不同渗透浓度晶体液对重度失血性休克大鼠血脑屏障(BBB)和脑水肿的影响。方法:雄性SD大鼠随机分成乳酸钠林格注射液(林格液)组、7.2%高渗氯化钠注射液(高渗盐)组和复方电解质注射液(复方电解质)组,每组50只,重度失血性休克[放血量占全身血容量的40%,平均动脉压(MAP)为35~45mmHg]维持1 h后分别输入乳酸钠林格注射液、复方电解质注射液或7.2%高渗氯化钠注射液;测定放血前(T0)、放血1 h(T1)、输液毕即刻(T2)、1 h(T3)、2 h(T4)血清S100B含量、脑组织伊文思蓝(EB)含量和干/湿质量比,电镜观察海马CA1区BBB改变。结果:三组T1~T4时间点血清S100B含量均比T0时升高(P<0.05)。高渗盐和复方电解质组在T3和T4时显著低于林格液组(P<0.01)。放血及输液前后脑组织EB含量无变化(P>0.05)。与T0比较,林格液组T1~T4时间点脑组织含水量都显著增加(P<0.05),高渗盐组仅在T1时增加(P<0.05),复方电解质组在T1、T2和T3时增加(P<0.05)。三组脑组织含水量在T0和T1时无显著差异(P>0.05);T2时高渗盐组脑组织含水量低于林格液组(P<0.01);T3和T4时高渗盐和复方电解质组都低于林格液组(P<0.01)。放血1 h后电镜下示血脑屏障发生改变,林格液组胶质细胞足突空泡化最明显,毛细血管周围水肿液最多。结论:重度失血性休克后BBB通透性和脑组织含水量增加,乳酸钠林格注射液复苏时短期内加重BBB损伤和脑水肿,7.2%高渗氯化钠注射液和复方电解质注射液复苏都能减轻BBB损伤和脑水肿,且7.2%高渗氯化钠注射液优于复方电解质注射液。
Objective: To compare the effects of three kinds of osmotic solutions on blood-brain barrier (BBB) and cerebral edema in rats with severe hemorrhagic shock. Methods: Male SD rats were randomly divided into lactated Ringer’s injection (Ringer’s solution) group, 7.2% hypertonic sodium chloride injection (hypertonic saline) group and compound electrolyte injection (compound electrolyte) , Severe hemorrhagic shock [blood volume accounted for 40% of systemic blood volume, mean arterial pressure (MAP) 35 ~ 45mmHg] were maintained 1 h after the injection of sodium lactate Ringer’s injection, compound electrolyte injection or 7.2% hyperosmotic chloride Sodium injection. The level of S100B and the content of Evans blue (EB) in brain tissue were measured before blood transfusion (T0), blood 1 h (T1), infusion at T2, 1 h (T3) and 2 h And dry / wet mass ratio, electron microscopy BBB changes in the hippocampal CA1 area. Results: The levels of serum S100B at T1 ~ T4 in three groups were higher than those at T0 (P <0.05). The hypertonic saline and compound electrolytes were significantly lower than those of Ringer’s solution at T3 and T4 (P <0.01). There was no change in EB content in brain tissue before and after blood transfusion and transfusion (P> 0.05). Compared with T0, brain water content increased significantly at T1 ~ T4 in Ringer’s fluid group (P <0.05), hypertonic saline group only increased at T1 (P <0.05), and at T1, T2 and T3 (P <0.05). There was no significant difference in brain water content between the three groups at T0 and T1 (P> 0.05); at T2, the water content of brain tissue in hypertonic saline group was lower than that of Ringer’s solution group (P <0.01) Compound electrolytes were lower than Ringer solution group (P <0.01). Blood 1 h after electron microscopy showed changes in the blood-brain barrier, the Ringer’s solution gliacytes podocytic vacuolar most obvious, most of the capillary around the edema. CONCLUSIONS: BBB permeability and brain water content increased after severe hemorrhagic shock. BBB injury and hydrocephalus increased rapidly in the course of resuscitation with Lactated Sodium Ringer’s Injection, 7.2% hypertonic sodium chloride injection and compound electrolyte injection resuscitated Can reduce BBB damage and cerebral edema, and 7.2% hypertonic sodium chloride injection is better than compound electrolyte injection.