Burris D, Rhee P, Kaufmann C, Pikoulis E, Austin B, Eror A, DeBraux S, Guzzi L, Leppäniemi A
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA.
J Trauma. 1999 Feb;46(2):216-23. doi: 10.1097/00005373-199902000-00003.
To test the hypothesis that controlled resuscitation can lead to improved survival in otherwise fatal uncontrolled hemorrhage.
Uncontrolled hemorrhage was induced in 86 rats with a 25-gauge needle puncture to the infrarenal aorta. Resuscitation 5 minutes after injury was continued for 2 hours with lactated Ringer's solution (LR), 7.3% hypertonic saline in 6% hetastarch (HH), or no fluid (NF). Fluids infused at 2 mL x kg(-1) x min(-1) were turned on or off to maintain a mean arterial pressure (MAP) of 40, 80, or 100 mm Hg in six groups: NF, LR 40, LR 80, LR 100, HH 40, and HH 80. Blood loss was measured before and after 1 hour of resuscitation.
Survival was improved with fluids. Preresuscitation blood loss was similar in all groups. NF rats did not survive 4 hours. After 72 hours, LR 80 rats (80%) and HH 40 rats (67%) showed improved survival over NF rats (0%) (p < 0.05). Rebleeding increased with MAP. Attempts to restore normal MAP (LR 100) led to increased blood loss and mortality.
Controlled resuscitation leads to increased survival compared with no fluids or standard resuscitation. Fluid type affects results. Controlled fluid use should be considered when surgical care is not readily available.
验证在其他情况下致命的失控性出血中，控制性复苏可提高生存率这一假说。
用25号针穿刺86只大鼠的肾下主动脉，诱导形成失控性出血。损伤后5分钟开始复苏，持续2小时，分别使用乳酸林格液（LR）、7.3%高渗盐水与6%羟乙基淀粉混合液（HH）或不输液（NF）。在六组中，以2 mL×kg⁻¹×min⁻¹的速度输注液体，或开启或关闭输液以维持平均动脉压（MAP）为40、80或100 mmHg，这六组分别为：NF、LR 40、LR 80、LR 100、HH 40和HH 80。在复苏1小时前后测量失血量。
输液可提高生存率。所有组复苏前的失血量相似。NF组大鼠存活时间未超过4小时。72小时后，LR 80组大鼠（80%）和HH 40组大鼠（67%）的生存率高于NF组大鼠（0%）（p < 0.05）。再出血随MAP升高而增加。试图恢复正常MAP（LR 100）会导致失血量增加和死亡率上升。
与不输液或标准复苏相比，控制性复苏可提高生存率。液体类型会影响结果。在无法立即进行手术治疗时，应考虑控制性液体使用。
