使用两剂4毫升/千克高渗盐水右旋糖酐进行烧伤复苏可实现持续的液体节省：一项针对清醒绵羊的48小时前瞻性研究。

Burn resuscitation with two doses of 4 mL/kg hypertonic saline dextran provides sustained fluid sparing: a 48-hour prospective study in conscious sheep.

作者信息

Elgjo G I, Traber D L, Hawkins H K, Kramer G C

机构信息

Department of Anesthesiology, University of Texas Medical Branch, Galveston, USA.

出版信息

J Trauma. 2000 Aug;49(2):251-63; discussion 263-5. doi: 10.1097/00005373-200008000-00011.

DOI:10.1097/00005373-200008000-00011

PMID:10963536

Abstract

BACKGROUND

The large fluid volumes usually required for burn resuscitation can be suppressed for 8 to 12 hours by intravenous infusion of 4 mL x kg(-1) hypertonic saline dextran (HSD) 1 hour after burn. We hypothesized that a double (8 mL x kg(-1)) dose of HSD or two repeated doses of 4 mL x kg(-1) could enhance or prolong the volume sparing.

METHODS

We produced a full-thickness flame burn covering 40% of the body surface on 18 anesthetized sheep. One hour after the burn, the animals were awake and resuscitated with either (1) lactated Ringer's solution (LR) only, (2) 8 mL x kg(-1) HSD followed by LR, or (3) 4 mL x kg(-1) HSD followed by LR, with a second dose of 4 mL x kg(-1) HSD administered when net fluid accumulation increased to 20 mL x kg(-1). For all regimens, infusion rates were adjusted to produce a urine output of 1 to 2 mL x kg(-1) x h(-1).

RESULTS

Animals resuscitated with only LR required fluid volumes identical to that predicted by the Parkland formula for the first 12 hours. Infusion of 8 mL x kg(-1) HSD initially created a net fluid loss (urine output > infused volume), followed by a rebound fluid requirement eventually equaling that of animals treated with LR only. Animals treated with two separate doses of 4 mL x kg(-1) HSD generally did not experience a net fluid loss or a rebound fluid requirement. Also in the HSD x 2 group, peak and net fluid accumulation was less than that of the other two groups from 18 hours through 48 hours, although the difference was not significant.

CONCLUSION

An initial 4 mL x kg(-1) dose of HSD reduces fluid requirements early after burn, and a second dose administered after an appropriate interval may prolong volume sparing through 48 hours. An 8 mL x kg(-1) continuously infused initial dose was without prolonged fluid sparing effect. The volume-sparing effect of HSD is thus dependent on all of the following: dose, dosing interval, and infusion rate.

摘要

背景

烧伤复苏通常所需的大量液体可在烧伤后1小时通过静脉输注4 mL·kg⁻¹高渗盐水右旋糖酐（HSD）而减少8至12小时。我们推测双倍剂量（8 mL·kg⁻¹）的HSD或两次重复剂量的4 mL·kg⁻¹可增强或延长液体节省效果。

方法

我们在18只麻醉的绵羊身上制造了覆盖40%体表的全层火焰烧伤。烧伤后1小时，动物清醒并进行复苏，复苏方式为：（1）仅用乳酸林格氏液（LR）；（2）8 mL·kg⁻¹ HSD后接LR；或（3）4 mL·kg⁻¹ HSD后接LR，当净液体蓄积量增加到20 mL·kg⁻¹时给予第二剂4 mL·kg⁻¹ HSD。对于所有方案，调整输注速率以产生1至2 mL·kg⁻¹·h⁻¹的尿量。

结果

仅用LR复苏的动物在最初12小时所需的液体量与帕克兰公式预测的量相同。输注8 mL·kg⁻¹ HSD最初导致净液体丢失（尿量＞输注量），随后出现液体需求反弹，最终与仅用LR治疗的动物相同。接受两次4 mL·kg⁻¹ HSD单独剂量治疗的动物一般未出现净液体丢失或液体需求反弹。同样在HSD×2组中，从18小时至48小时，峰值和净液体蓄积量低于其他两组，尽管差异不显著。