鎽樿

锛�1锛夎儗鏅細

楂樻徊涔抽吀閳夛紙HSL锛夊彲鑳藉湪鐐庣櫏閬庣▼涓捣浣滅敤銆傛垜鍊戞棬鍦ㄨ⿻浼板叾鍦ㄥぇ榧犲椹楁€ц喛姣掔櫏锛堢洸鑵哥祼(ji茅)鎵庣┛鍒猴紙CLP锛夛級鏈熼枔鐨勪綔鐢�銆�

锛�2锛夋柟娉曪細

鍒嗕笁绲勶紙n=10/绲勶級锛氬亣鎵嬭(sh霉)绲勩€丆LP-NaCl 0.9%鍜孋LP-HSL锛圕LP鍚�2.5ml/kg/h娑查珨18灏忔檪锛�銆傝⿻浼�鑵哥郴鑶滃井寰挵(hu谩n)銆佽秴鑱插績鍕曞湒銆佺窗(x矛)鑳炲洜瀛愬拰鐢熷寲鍙冩暩(sh霉)銆傚皪姣涚窗(x矛)琛€绠℃徊婕�锛圗vans blue锛宯=5/绲勶級鍜�蹇冭嚐琛€娴佸嫊鍔涘(xu茅)锛坣=7/绲勶級閫�(j矛n)琛屼簡鍙﹀鍏╅爡瀵﹂銆�

锛�3锛夌祼(ji茅)鏋滐細

HSL鏀瑰杽浜嗚吀绯昏啘寰惊鐠�(hu谩n)銆佸績杓稿嚭閲忓拰宸﹀績瀹ょ煭绺垎?j菒n)?sh霉)銆侶SL閭勬彁楂樹簡dP/dtmax鏂滅巼锛岄檷浣庝簡宸﹀鑸掑嫉鏈-瀹圭⿳闂�(gu膩n)绯�锛屽苟娓涘皯浜嗚吀閬撱€佽偤鍜岃倽鑷熶腑鐨勪紛鏂囨€濊棈(l谩n)鎿�(ku貌)鏁�銆備钩閰稿拰3-缇ュ熀涓侀吀鍦–LP-HSL涓純楂樸€侶SL鎮ｈ€呯殑琛€婕跨窗(x矛)鑳炲洜瀛愶紙IL-1尾锛孴NF伪锛孖L-10锛変互鍙婅婕縑EGF-A娓涘皯銆�

锛�4锛夌祼(ji茅)璜�

楂樻徊涔抽吀閳夋恫鍙爯(y霉)闃茶喛姣掔櫏鏅傜殑蹇冨姛鑳戒笉鍏�銆佽吀绯昏啘寰惊鐠�(hu谩n)鏀硅畩鍜屾瘺绱�(x矛)琛€绠℃徊婕�锛屽悓鏅傛笡灏戠値鐧ュ苟澧炲挤(qi谩ng)閰珨銆�

Material and methods

鍓嶇珯銆侀毃姗�(j墨)銆佸皪鐓х殑鐮旂┒瑷�(sh猫)瑷堝強鍊悊

鍕曠墿绋嬪簭

涓昏鐩殑鏄瘮杓僅SL鍜�0.9%NaCl灏嶅井寰挵(hu谩n)鐨勫奖闊�?锛涱媱?/span>鍏堝墠鐨勬暩(sh霉)鎿�(j霉)[21]锛屾垜鍊戦爯(y霉)鍏堣▓绠椾簡姣忕祫10鍙泟鎬prague-Dawley澶ч紶锛�400-500g锛夌殑鏁�(sh霉)閲�锛�瓒充互纰哄畾寰惊鐠�(hu谩n)娴侀噺宸暟20%锛屛遍ⅷ(f膿ng)闅偤5%锛屾晥鑳界偤90%銆�娆¤鐩(bi膩o)鏄績鍔熻兘銆佹瘺绱�(x矛)琛€绠℃徊婕忋€佺値鐧ュ拰浠ｈ瑵銆傜敱浜庤垏寰惊鐠�(hu谩n)鐮旂┒涓嶅吋瀹�锛屽叾涓竴浜涚洰妯�(bi膩o)闇€瑕侀澶栫殑鍕曠墿銆傛牴鎿�(j霉)鎴戝€戜箣鍓嶇殑缍�(j墨ng)椹�锛孍vans blue鍜屽鍔�-瀹圭⿳鍥炶矾鍒嗗垾鐐烘瘡绲�5鍙嫊鐗╁拰7鍙嫊鐗�銆�

瀵﹂娴佺▼

閫氶亷鐩茶吀绲�(ji茅)鎵庣┛鍒猴紙CLP锛夎獦灏�(d菐o)鑶挎瘨鐧�銆傞€氶亷鑵硅厰娉ㄥ皠姘兒閰�/鐢茶嫰鍣诲棯锛�75/5mg/kg锛夐夯閱夊嫊鐗�銆傚皣3-F鑱氭皑閰亴娉ㄥ皫(d菐o)绠℃彃鍏ュ彸闋搁潨鑴�銆傜祼(ji茅)鎵庣洸鑵革紙鍗犵洸鑵搁珨绌嶇殑75%锛夊苟鍒虹┛鐩茶吀锛�16鍏嬮嚌闋級浠ヤ娇绯炰究澶栭儴鍖�銆傚湪鎵嬭(sh霉)绲�(ji茅)鏉熸檪锛屽皣鍕曠墿闅ㄦ(j墨)鍒嗙偤鍥涚祫锛氭帴鍙�11.2%涔抽吀閳夌殑CLP-HSL锛�1000 mmol/L閳�+1000 mmol/L涔抽吀閳�锛屾硶鍦婣PHP锛�锛屾帴鍙�0.9%NaCl鐨凜LP-NaCl锛�154 mmol/L姘�+154 mmmol/L閳夛級锛屾帴鍙�8.4%纰抽吀姘垑鐨凜LP-HSB锛�1000 mmmol/L纰抽吀姘垑+1000 mm/L閳夛級锛屽亣鎵嬭(sh霉)閲囩敤瀹牳鍒囬枊琛�(sh霉)鍜屽墫鑵硅(sh霉)锛屼絾涓嶄娇鐢ㄥ皫(d菐o)绠�/CLP銆備笉骞哥殑鏄�锛孒SB绲�6鍙ぇ榧犱腑鍙湁2鍙瓨娲汇€傚嚭浜庨亾寰峰師鍥�锛屽苟鏍规摎(j霉)鐐烘湰鐮旂┒鎻愪緵鐨勫悎娉曟巿娆�(qu谩n)锛屾垜鍊戞湭瀹屾垚鏈祫鐮旂┒銆侰LP澶ч紶鐒℃硶鐛插緱姘村拰椋熺墿锛屽苟鎺ュ彈浜�18灏忔檪鍏�(n猫i)2.5姣崌/鍗冨厠/灏忔檪鐨勭爺绌舵恫楂旇几娉�銆傚悜CLP-NaCl婧舵恫涓坊鍔�8%鐨勫彅涓佸熀钁¤悇绯栵紝浠ョ敘(ch菐n)鐢熻垏CLP-HSL绲勭浉鍚岀殑鐔遍噺[20]銆傚椹椾腑鐨勫ぇ榧犺鍠崹闂�(gu膩n)鍦ㄧ睜瀛愰噷銆傚湪浣跨敤姘兒閰�/鐢茶嫰鍣诲棯锛�75/5 mg/kg锛夐夯閱夊悗锛屽鐝�(xi脿n)浜嗕笁绲勪笉鍚岀殑瀵﹂锛氾紙1锛夎秴鑱插績鍕曞湒鍜屾縺鍏夋枒榛炴垚鍍忥紙n=10/绲勶級锛岋紙2锛変紛鏂囨€濊棈(l谩n)娓畾锛坣=5/绲勶級锛屾垨锛�3锛夊鍔�-瀹圭⿳鍥炶矾锛坣=7/绲勶級銆�

锛�1锛夎秴鑱插績鍕曞湒

鍦ㄩ夯閱変笅瀵︾従(xi脿n)瓒呰伈蹇冨嫊鍦�锛屽苟浣跨敤M妯″紡娓噺宸﹀鑸掑嫉鏈湡鍜屾敹绺湯鏈熺洿寰戯紙LVEDD鍜孡VESD锛夛紝寰炶€岃▓绠楀乏瀹ょ府鐭垎?j菒n)?sh霉)锛圠VFS锛�銆傝剤娌栨尝澶氭櫘鍕掔敤浜庨噰闆嗗拰瑷堢畻浜屽皷鐡/A姣�銆傞€氶亷杩戠鑲哄嫊鑴堟脯閲忔瘡鍏嬪嫊鐗╃殑蹇冭几鍑洪噺銆�

锛�2锛夎吀绯昏啘鐏屾敞

瓒呰伈蹇冨嫊鍦栨鏌ュ悗锛岄€氶亷婵€鍏夋枒榛炲皪姣旀垚鍍忓皪鑵搁亾閫�(j矛n)琛屽井寰挵(hu谩n)閲囬泦銆傚湪閬�(yu菐n)闆㈢┖鑵搁儴浣嶇殑鍥涘€嬬浉浼兼劅鑸堣叮鍗€(q奴)鍩�?q奴)宕縁(xi脿n)鍦栧儚鍒嗘瀽锛屽钩鍧囧€艰〃绀虹偤鐏屾敞鍠綅锛圥U锛夈€�

锛�3锛夋瘺绱�(x矛)琛€绠℃徊婕忓拰浼婃枃鎬濊棈(l谩n)娓畾

闈滆剤娉ㄥ皠浼婃枃鎬濊棈(l谩n)锛�45鍒嗛悩鍚庣敤澶氳仛鐢查啗灏囧叾寰炶娴佷腑娌栨礂鎺�銆傚績鑷燂紙宸﹀績瀹わ級銆佽偤銆佽吀閬撳拰鑲濊嚐妯ｅ搧鍦�60掳C涓嬭劔姘�5澶�锛岀劧鍚庡湪37掳C涓嬪湪10%鐢查叞鑳轰腑瀛佃偛3澶┿€備娇鐢ㄥ垎鍏夊厜搴︽硶鍦�620nm铏曟脯閲忛洟蹇冧笂娓呮恫鐨勫惛鍏夊害銆�

鍦–LP-NaCl鍜孋LP-HSL绲勪腑瑷橀寗娑查珨骞宠　锛堝翱閲忓拰杓告敞娑查珨涔嬮枔鐨勫樊鐣帮級銆�

锛�4锛夎娴佸嫊鍔涘(xu茅)

鐛插緱宸﹀績瀹わ紙LV锛夌殑澹撳姏-瀹圭⿳鐠�(hu谩n)鍜岃娴佸嫊鍔涘(xu茅)銆傝閷�/瑷堢畻宸﹀鏀剁府澹擄紙LVESP锛夈€佸乏瀹よ垝寮靛锛圠VEDP锛�銆乨P/dtmin銆乨P/dtmax鍜屽乏瀹よ垝寮靛父鏁�(sh霉)tau锛圵eiss娉曪級銆傝▓绠桳VESP鍜孡VEDP闂�(gu膩n)绯伙紙LVESPVR鍜孡VEDPVR锛夛紝浣滅偤璨�(f霉)鑽风劇闂�(gu膩n)鐨勫乏瀹ゆ敹绺姛鑳藉拰宸﹀闋嗘噳(y墨ng)鎬х殑鎸囨(bi膩o)銆傚湪绋嬪簭绲�(ji茅)鏉熸檪閲囬泦琛€妯ｏ紝浣跨敤鍐峰噸婊查€忓瑷堟脯閲忓拰姣旇純琛€婕挎徊閫忓锛坢osmol/kg锛�銆�

锛�5锛夌敓鐗╁(xu茅)鍙冩暩(sh霉)

鍦ㄦ墜琛�(sh霉)绲�(ji茅)鏉熸檪锛岄噰闆嗘渶澶ч珨绌嶇殑琛€娑�銆�

锛�6锛夌値鐧ュ拰姣涚窗(x矛)琛€绠℃徊婕忕浉闂�(gu膩n)妯�(bi膩o)蹇楃墿

IL-1尾銆乀NF伪鍜孖L-10锛涗娇鐢‥LISA娓畾琛€绠″収(n猫i)鐨敓闀峰洜瀛怉鍨嬶紙VEGF-A锛夊拰syndecan-1銆�

锛�7锛夌敓鐗╁寲瀛�(xu茅)

銆€銆€鍦ㄨ娑插拰灏挎恫涓脯閲忓翱绱�銆侀垑銆侀墍鍜屾隘鍖栫墿銆傚湪琛€娑蹭腑娓噺鐧借泲鐧姐€傝▓绠楀椹楁湡闁撴帓鍑虹殑闆㈠瓙鐨勭禃灏嶉噺锛岃▓绠楁暣鍊嬪椹楁湡闁撴敞鍏ョ殑闆㈠瓙閲忓拰鎺掑嚭鐨勯洟瀛愰噺涔嬮枔鐨勫樊鐣帮紝骞跺弽鏄犲嚭鍦ㄨ几娉ㄦ湡闁撻珨鍏�(n猫i)閬庨噺鐨勯洟瀛�銆�

锛�8锛夋柊闄充唬璎�

娓畾琛€绯�銆佷钩閰搞€佷笝閰吀銆�3-缇ュ熀涓侀吀鍜屼箼閰颁箼閰哥殑琛€鍚噺銆�

锛�9锛夌当(t菕ng)瑷堝垎鏋�

浣跨敤閬�(d谩)鎴堟柉钂傝妾㈤瑭曚及鏁�(sh霉)鎿�(j霉)鍒嗗竷锛屾暩(sh霉)鎿�(j霉)浠ュ洓鍒嗕綅闁撹窛[IQ1鈥揑Q3]鎴栨(bi膩o)婧�(zh菙n)鍋忓樊锛埪盨D锛夌殑鍧囧€艰〃绀�銆傛牴鎿�(j霉)鍒嗗竷鐨勬鎱�(t脿i)鎬э紝浣跨敤闈炲弮鏁�(sh霉)妾㈤锛圞ruskal Wallis鎴朚ann-Whitney锛夋垨鍙冩暩(sh霉)妾㈤锛圓NOVA鎴杢-Student锛夊鐝�(xi脿n)绲勯枔姣旇純锛屽鏋滅祼(ji茅)鏋滈’钁�锛屽墖浣跨敤Dunn鎴朒olm-Sidak鐨勫閲嶆瘮杓冩椹楅€�(j矛n)琛屼簨鍚庡垎鏋�銆傚鐝�(xi脿n)浜嗗叐鍊嬫瘮杓冿細CLP-NaCl绲勮垏鍋囨墜琛�(sh霉)绲勫拰CLP-NaCl绲勮垏CLP-HSL绲勩€�鍥犵偤鎴戝€戞棬鍦ㄨ⿻浼癏SL鍦ㄨ喛姣掔櫏鏈熼枔鐨勪綔鐢�锛屾墍浠ham鍜孋LP-HSL涔嬮枔鐨勬瘮杓冨苟涓嶇浉闂�(gu膩n)锛屽彲鑳芥渻闄嶄綆鍒嗘瀽鐨勮兘鍔�銆�鎵€鏈夋瘮杓冨潎浣跨敤Prism v8.0锛堢編鍦婫raphPad锛夊鐝�(xi脿n)銆俻<0.05琚獚(r猫n)鐐烘槸椤憲鐨勩€傚鏋滅己灏戦棞(gu膩n)浜庢瘡绲勫椹楁瑕佺祩榛炵殑鏁�(sh霉)鎿�(j霉)锛屽墖鎳�(y墨ng)鐢ㄥ皪鐓х祫鐨勪腑鍊间締鏀寔鐒℃晥鍋囪ō(sh猫)銆�

绲�(ji茅)鏋�

鍦ㄦ瘡绲�22鍙ぇ榧犱腑锛�3绲勫椹楋級锛孋LP-HSL绲�2鍙拰CLP-NaCl绲�1鍙湪鐏屾敞绲�(ji茅)鏉熷墠姝讳骸锛堣(b菙)鍏呮柊澶ч紶锛�銆�

锛�1锛夎吀绯昏啘鐏屾敞

鑸囧亣鎵嬭(sh霉)绲勭浉姣旓紝CLP-NaCl绲勭殑鑵哥郴鑶滅亴娉ㄥ钩鍧囧€奸’钁楅檷浣庯紙286卤129灏�957卤169 PU锛宲<0.0001锛夈€傜浉鍙�锛岃垏姘寲閳夌浉姣�锛孒SL椤憲澧炲挤(qi谩ng)浜咰LP澶ч紶鐨勭亴娉紙712卤366灏�286卤129 PU锛宲=0.0006锛屽湒1锛�銆�

鍦�1. 婵€鍏夋暎鏂戞垚鍍忚⿻鍍硅吀绯昏啘寰惊鐠�(hu谩n)

锛�2锛夋瘺绱�(x矛)琛€绠℃徊婕�

鑸囧亣鎵嬭(sh霉)绲勭浉姣�锛孋LP-NaCL绲勭殑鑲猴紙300[253-452]vs.149[83-152]锛宲=0.04锛�锛岃吀閬擄紙113[88-189]vs.35[21-41]锛宲=O.009锛夊拰鑲濊嚐锛�70[50-89]vs.18[15-26]锛宲=o.02锛夌殑浼婃枃鎬濊棈(l谩n)鎿�(ku貌)鏁ｅ鍔狅紙鍦�2锛�銆傚績鑷熸矑鏈夎瀵熷埌宸暟銆傜浉鍙�锛屽湪CLP澶ч紶涓紝鑸嘚aCl鐩告瘮锛孒SL灏�(d菐o)鑷磋偤锛�94[78-136]vs.300[253-452]锛宲=0.006锛夈€佽吀閬擄紙37[31-43]vs.113[88-189]锛宲=0.03锛夊拰鑲濊嚐锛�24[14-37]vs.70[50-89]锛宲=0.04锛夌殑浼婃枃鎬濊棈(l谩n)鎿�(ku貌)鏁ｆ笡灏�锛屼絾蹇冭嚐娌掓湁銆傚悓妯�锛孒SL鑸嘚aCl鐩告瘮椤憲鏀瑰杽浜嗘祦楂斿钩琛�(? 1.5 [? 1.7鑷�? 0.7]vs.2.0[1.6鈥�2.2]mL/kg/h锛宲=0.002锛�锛孒SL澶ч紶鐨勫翱閲忛’钁楄純楂橈紙3.9[3.2鈥�4.1]vs.0.3[0.3鈥�0.8]mL/鍗冨厠/h锛宲=0.008锛夛紙鍏╃祫鐨勮几娑查噺鍧囩偤2.5 mL/kg/h锛屽鈥滄潗鏂欏拰鏂规硶鈥濅竴绡€(ji茅)鎵€杩帮級銆�

鍦�2. 鍦ㄨ偤锛坅锛�銆佽吀锛坆锛�銆佽倽锛坆锛夊拰蹇冭嚐锛坉锛変腑浣跨敤浼婃枃鎬濊棈(l谩n)娓畾娉曪紙n=5/绲勶級妾㈡脯姣涚窗(x矛)琛€绠℃徊婕�銆傛恫楂斿钩琛＄祼(ji茅)鏋滐紙e锛�銆佸翱閲忓拰杓告敞娑查珨绲�(ji茅)鏋滐紙f锛�

锛�3锛夎秴鑱插績鍕曞湒

鑸囧亣鎵嬭(sh霉)绲勭浉姣�锛孋LP-NaCl绲勭殑蹇冭嚐杓稿嚭閲忔笡灏戯紙0.14[0.01-0.18]灏�0.30[0.26-0.34]mL/min/g锛宲=0.004锛夛紝鐩＄宸﹀鐭府鍒�?j菒n)?sh霉)娌掓湁宸暟锛�39[33-52]灏�44[41-47]銆傞棞(gu膩n)浜庢垜鍊戞ā鍨嬩腑鍙敤鐨勫墠璨�(f霉)鑽烽潨鎱�(t脿i)鎸囨(bi膩o)锛孋LP-NaCl绲勮垏鍋囨墜琛�(sh霉)绲勭浉姣擫VEDD闄嶄綆锛�6.2[5.2鈥�7.3]vs.9.4[8.8鈥�9.6]mm锛宲=0.001锛�锛屼絾鍦‥/A浜屽皷鐡ｈ娴佹瘮鏂归潰娌掓湁瑙€瀵熷埌宸暟锛�1.3卤0.4 vs.1.7卤0.5锛宲=1.2锛�銆�

HSL vs.NaCl椤憲鏀瑰杽浜�楂樺績鎺掕閲忥紙0.34[0.28鈥�0.43]vs.0.14[0.01鈥�0.18]mL/min/g锛宲<0.0001锛夊拰鐭府鍒�?j菒n)?sh霉)锛�55[46鈥�73]vs.39[33鈥�52]%锛宲=0.009锛夌殑CLP澶ч紶鐨勫乏瀹ゆ敹绺姛鑳�銆傛湭瑙€瀵熷埌鑸囬爯(y霉)璨�(f霉)鑽烽潨鎱�(t脿i)鎸囨暩(sh霉)鐩搁棞(gu膩n)鐨勫樊鐣般€�

鍦�3 缍�(j墨ng)鑳歌秴鑱插績鍕曞湒

锛�4锛塋V pressure-volume loops

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琛�1锛氭湁鍓�(chu脿ng)琛€娴佸嫊鍔涘(xu茅)鍙冩暩(sh霉)鍜屽鍔�-瀹圭⿳鍥炶矾锛�n=7/绲勶級

锛�5锛夌敓鐗╁(xu茅)鍙冩暩(sh霉)

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闂�(gu膩n)浜庝唬璎濓紝CLP-NaCl绲勮垏鍋囨墜琛�(sh霉)绲勭浉姣�锛岃绯栭檷浣庝簡鍏╁€�锛岃婕�3-缇ュ熀涓侀吀娓涘皯銆傜浉鍙�锛岃垏NaCl鐩告瘮锛孒SL鑸囪純楂樼殑琛€绯�銆佷钩閰搞€佷笝閰吀鍜�3-缇ュ熀涓侀吀鐨勮婕挎按骞崇浉闂�(gu膩n)锛屼絾鍏╃祫涔嬮枔涔抽吀/涓欓叜閰告瘮鐜囨矑鏈夊樊鐣�銆�

锛�6锛夌値鐧�

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鍋囨墜琛�(sh霉)绲�銆丆LP-NaCl绲勫拰CLP-HSL绲勪箣闁撶殑VEGF-A鎴杝yndecan-1鐒″樊鐣�锛屼絾CLP-NaCl绲勮垏CLP-HSL绲勪箣闁撶殑VEGF-A姘村钩闄嶄綆銆�

绺界祼(ji茅)锛氱附涔�锛屽湪瀵﹂鎬ц喛姣掔櫏妯″瀷涓娇鐢ㄩ珮婊蹭钩閰告恫楂斿彲浠ユ敼鍠勫井寰挵(hu谩n)銆佹瘺绱�(x矛)琛€绠℃徊婕忎互鍙婂績鑷熷拰鑵庤嚐鍔熻兘锛屽彲鑳介€氶亷浠ｈ瑵鍜岀値鐧ラ€斿緫瀵︾従(xi脿n)銆傚椹楀拰鑷ㄥ簥鐮旂┒閮芥湁蹇呰娣卞寲HSL鏀瑰杽鑶挎瘨鐧ョ殑姗�(j墨)鍒讹紝浠ュ強鍙兘杞�(zhu菐n)绉诲埌鑷ㄥ簥鑶挎瘨鐧ョ殑娌荤檪涓�銆�