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目的 探讨高渗氯化钠右旋醣酐 (7.5 %NaCl 6 %Dextran4 0 ,HSD)与多巴胺 (DA)合用对初进高原大鼠失血性休克合并肺水肿的的治疗效果。方法 初进高原SD大鼠 4 2只 ,复制失血性休克合并肺水肿模型。实验分为非处理组、失血性休克合并肺水肿对照组、乳酸林格氏液对照组 (4ml kg ,LR)、HSD单用组(4ml kg)、多巴胺单用组 (2mg kg ,DA)和HSD与DA合用组 ,每组 7只动物。观察给药后 15、30、6 0和 12 0分钟时相点大鼠血流动力学指标变化、30分钟和 12 0分钟大鼠血气指标变化以及 12 0分钟大鼠肺脑含水量变化。结果 HSD或DA单用可显著升高休克合并肺水肿大鼠血压 (MAP)、左心室内压 (LVSP)和左室内压最大变化速率 (±dp dtmax)等血流动力学指标 (P <0 .0 5～ 0 .0 1) ,改善部分血气指标如pH值、[HCO3- ]、血氧饱和度 (O2 sat)和降低肺、脑含水量。二者合用效果优于两者单用。结论 HSD与DA伍用有较好的改善高原失血性休克合并肺水肿的血流动力学指标 ,改善血气指标和减轻肺水肿的作用 ,可作为治疗高原休克合并肺水肿的早期救治措施之一。
Objective To investigate the therapeutic effect of combination of hypertonic sodium chloride dextran (7.5% NaCl 6% Dextran 4 0, HSD) and dopamine (DA) on hemorrhagic shock with pulmonary edema in rats. Methods Four 2 SD rats were randomly divided into three groups: model of hemorrhagic shock and pulmonary edema. The experiment was divided into non-treatment group, hemorrhagic shock with pulmonary edema control group, lactated Ringer’s solution control group (4ml kg, LR), HSD single group (4mlkg), dopamine group HSD combined with DA group, 7 animals per group. The change of hemodynamics, the change of blood gas of rats at 30 minutes and 120 minutes, and the change of water content of the lung brain at 120 minutes were observed at 15, 30, 60 and 120 minutes after administration. Results HSD or DA alone could significantly increase hemodynamic parameters such as MAP, LVSP and ± dp dtmax in shock-associated pulmonary edema (P <0 .0 5 ~ 0 .0 1), improve some blood gas indicators such as pH, [HCO3-], oxygen saturation (O2 sat) and reduce lung and brain water content. The combined effect is better than both alone. Conclusion The combination of HSD and DA has better hemodynamic indexes for hemorrhagic shock combined with pulmonary edema, improves blood gas index and relieves pulmonary edema. It may be used as an early treatment for shock-induced pulmonary edema in high altitude.