等容血液稀释法治疗脑损伤的实验研究
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ANXE PERIMENTAL STUDY OF THE TREATMENT OF TRAUMATIC BRAIN INJURY WITH ISOVOLUMETRIC HEMODILUTION
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    摘要:

    本文选用32只成年健康狗,造成脑挫裂伤模型,随机分成四组:Ⅰ.对照组;Ⅱ.常规治疗组;Ⅲ.常规加DX40组;Ⅳ.等容血液稀释组(IHD)。监测伤前,治疗前后血液流变学、颅内压,血流动力学指标;并对狗脑损伤部位进行病理学检查。结果显示:脑损伤后红细胞压积(HCT)、高、低切变率下的表观粘度(η51.2,η0.512)、全血复粘度的粘性分量(η')、弹性分量(η'')、弹性模量(G')、红细胞聚集指数(AI)及颅内压(ICP)明显增高。Ⅱ组治疗后1小时,HCT,η0.512,η51.2,AI,η',η'',G'明显下降,2小时后又升至伤前水平;Ⅲ和Ⅳ组治疗后2小时、8小时,除η51.2外,其余血液流变学指标均下降,明显低于Ⅰ、Ⅱ组。而在治疗后8小时,Ⅳ组的ICP明显低于其余各组。病理结果表明,损伤灶周围脑水肿及损伤反应,Ⅲ和Ⅳ组明显轻于其它两组。本研究表明,IHD可降低血液粘度与红细胞聚集,从而改善微循环,有助于减轻脑的继发性损害。但IHD仍不能完全代替综合治疗,是一种重要的辅助治疗手段。

    Abstract:

    Thirty-two dogs were divided into 4 equal groups randomly following experimental traumatic brain injury.Group I,as control,without any treatment after injury,GroupⅡ,Ⅲ,Ⅳ were treated by mannitol,mannitol adding DX 40 and isovolumetric hemodilution(IHD)respectively after injury.Hemorheology,hemodynamic parameters and intracranial pressure(ICP)were monitored at different intervals during the study,Meanwhile the traumatic brains were examined pathologically.The results demonstrated that hematocrit(HCT),blood apparent viscosity at low and high shear rates(η0.512,η51.2).erythrocyte aggregation index(AI),viscous component(η'),elastic component(η''),elastic modules(G') and ICP increased Significantly after brain injury.In group Ⅱ,HCT,η0.512,η51.2,AI-η',η''decreased obviously at 1 hour after therapy,but increased to the level before in jury at 2 hours after therapy.Except for η51.2,the rest of hemorheol logical parameters decreased significantly in group Ⅲ and IV at 2 hours and 8 hours after therapy,While ICP in group IV was lower than that of the other groups at 8 hours after therapy The Study indicated that IHD is particularly effective in lowering blood viscosity,vlscoelasticity and erythrocyte aggregation,IHD does not result in an increase in cardiac output or ICP,IHD can lead to reduction in cerebra vascular resistance and increasing blood volume in microcirculation and can reduce cerebral edema and the extent of brain damage.We suggest that it is important to examine HCT during the routine treatment of traumatic brain injury and IHD is one of the safe,acceptable and effective therapies in the treatment of brain injury.

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李良,陈槐卿,杨怡静,冯新明,吴文超,王茂德,高立达,李能德,毛伯镛.等容血液稀释法治疗脑损伤的实验研究[J].医用生物力学,1994,9(3):148-155

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