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目的 探讨高渗醋酸钠右旋醣酐 (HAD)与多巴胺 (DA)伍用对初进高原大鼠失血性休克伴肺水肿的治疗效果。 方法 初进高原 (西藏拉萨 )SD大鼠 4 2只 ,戊巴比妥钠 (30mg kg)腹腔注射麻醉 ,维持血压在 5 0mmHg ,同时加油酸 (5 μl 10 0g)静脉注射维持 1h复制失血性休克合并肺水肿模型。实验分为正常对照组 (不放血、不给油酸 )、休克合并肺水肿对照组、乳酸林格液(4ml kg ,LR)对照组、HAD(4ml kg)单用组、DA(2mg kg)单用组和HAD +DA组 ,每组 7只大鼠。观察给药后 15 ,30 ,6 0和 12 0min时血流动力学指标的变化 ,给药后 30和 12 0min时血气指标的变化和 12 0min时肺、脑含水量的变化。 结果 与LR对照组比较 ,HAD和DA单用可显著升高休克合并肺水肿大鼠平均动脉压 (MAP)、左心室收缩压 (LVSP)和左室内压最大变化速率 (±dp dtmax)等指标 (P <0 .0 5和 0 .0 1) ,改善部分血气指标如血氧饱和度和降低肺、脑含水量。二者伍用时其升高MAP、LVSP和±dp dtmax的作用和降低肺、脑含水量的作用效果显著优于两者单用 (P <0 .0 5和0 .0 1)。 结论 HAD与DA伍用可较好地改善高原失血性休克合并肺水肿大鼠血流动力学指标和血气指标 ,并减轻肺水肿 ,二者伍用优于单用效果 ;二者联合用药可用于高原休克的早期救治。
Objective To investigate the therapeutic effect of hypertonic sodium acetate dextran (HAD) combined with dopamine (DA) on the hemorrhagic shock and pulmonary edema in rats with advanced plateau. Methods Forty two Sprague-Dawley (SD) rats in Lhasa Plateau (Tibet) were injected intraperitoneally with pentobarbital sodium (30 mg kg) to maintain the blood pressure at 50 mmHg. Meanwhile, oleic acid (5 μl, 10 g) Shock combined with pulmonary edema model. The experiment was divided into normal control group (no bleeding, no oleic acid), shock combined with pulmonary edema control group, lactated Ringer’s solution (4mlkg, LR) control group, HAD Single-use group and HAD + DA group, each group of 7 rats. The changes of hemodynamics at 15, 30, 60 and 120 min after administration were observed. The changes of blood gas indexes at 30 and 120 min after administration and the changes of lung and brain water content at 120 min were observed. Results Compared with LR control group, HAD and DA alone could significantly increase the mean arterial pressure (MAP), left ventricular systolic pressure (LVSP), and ± dp dtmax in shock-associated pulmonary edema (P <0.05 and 0.01), improve some blood gas indicators such as oxygen saturation and reduce lung and brain water content. The effect of raising the MAP, LVSP and ± dp dtmax and reducing the water content of the lung and brain in both groups were significantly better than those of the two alone (P <0.05 and 0.01). Conclusions The combination of HAD and DA can improve hemodynamics and blood gas indexes and reduce pulmonary edema in rats with hemorrhagic shock and pulmonary edema at high altitude. The combination of HAD and DA is better than single use. Early treatment of high altitude shock.