Experimental Research On The Effect Of Different Infusion Rate Of 7.5% Hypertonic Saline On Intracranial Pressure In Patients With Traumatic Brain Injury

Objective:A rat model of severe craniocerebral injury,and compare the effects of three different dosages of 7.5%hypertonic saline on cerebral edema and intracranial pressure.In order to provide evidence-based evidence for clinical treatment,the mechanism of brain edema and the key points of treatment were discussed through the effects of the water channel protein-4(aquaporin-4,AQP-4)and Na+-K+-2C1-common transporter 1(NKCC1)mRNA and protein expression on the brain edema.Method:First,100 SD rats all groups established a rat model of brain injury according to the free fall impact method.Rats were randomly divided into control group(CG),group A(fast infusion group)B group(first fast and slow infusion group),and C group(slow infusion group).After 12 hours of modeling,the rats in groups A,B and C were injected with 7.5%hypertonic saline at the rate of administration and placed in the intracranial pressure probe.The rat blood pressure detector was connected and the intracranial pressure and blood pressure were recorded for 10 minutes.Three times,after 6 hours of observation,the rats were sacrificed by excessive injection of anesthetic,and the brain tissue and lung tissue were taken out.The injured brain tissue was immersed in 4%paraformaldehyde,and the other brain tissue was placed in a cryopreservation box and stored at-80℃.Brain was found by RT-PCR,immunohistochemistry and WB to detect the changes of AQP4 and NKCC1 mRNA and protein,and the lung tissue was tested for dry and wet specific gravity.According to the inclusion and exclusion criteria,30 patients with traumatic brain injury were selected and chosen two delivery rates.according to the order of admission.Both groups were injected with 7.5%hypertonic saline 100 mL.One group used the best drug delivery rate in animal experiment and the other group used clinical routine speed.Arterial blood was taken 6 h after administration,serum was separated,and serum AQP-4,NKCC1,TNF-α,IL-1β,and IL-6 levels were detected by ELISA.Result:The intracranial pressure of the experimental group was lower than that of the control group,and the fast infusion group had the fastest effect and the intracranial pressure was the lowest.There was a statistically significant difference between the AQP4 and NKCC1 controls in the experimental group(P<0.05).Compared with the normal range of serum electrolytes in rats,serum sodium,serum chlorine and serum potassium in the experimental group were within the normal range.Clinical trial results showed that both infusion rates of 7.5%hypertonic saline reduced intracranial pressure,but the effect of reducing intracranial pressure was more pronounced in the fast infusion group.Both infusion rates have less effect on blood pressure.Elisa results showed that AQP4 and NKCC1 decreased with increasing number of days of administration in both groups.There were no significant differences in serum electrolytes,urea nitrogen and creatinine between the two groups before and after administrationConclusion:(1)Different administration rates of 7.5%hypertonic saline reduced intracranial pressure in patients with traumatic brain injury(2)The rapid administration of 7.5%hypertonic saline is superior to slow administration and rapid and slow administration(3)7.5%of hypertonic saline different infusion rates did not cause electrolyte imbalance in patients.