Friedman Zeev, Berkenstadt Haim, Preisman Sergei, Perel Azriel
Department of Anesthesiology and Intensive Care, The Chaim Sheba Medical Center, Tel Hashomer, Israel (affiliated with the Sackler School of Medicine, Tel Aviv University).
Anesth Analg. 2003 Jan;96(1):39-45, table of contents. doi: 10.1097/00000539-200301000-00009.
In this randomized, controlled study in dogs, we examined the short-term effects of blood pressure targeted fluid resuscitation with colloids or crystalloids solutions on systemic oxygen delivery, and lactate blood concentration. Fluid resuscitation using hydroxyethyl starch (HES) 6% to a mean arterial blood pressure (MAP) of 60 mm Hg was compared with lactated Ringer's solution (LR) to a MAP of 60 or 80 mm Hg (LR60 and LR80, respectively). The model was one of withdrawal of blood to a MAP of 40 mm Hg through an arterial catheter that was then connected to a system allowing bleeding to occur throughout the study whenever MAP exceeded 40 mm Hg. Target MAP was maintained for 60 min with a continuous infusion of the designated fluid replacement. All 15 dogs (5 in each group) survived until the last measurement. Blood loss in the LR80 group (2980 +/- 503 mL) (all values mean +/- SD) was larger than in the LR60 and HES60 groups (1800 +/- 389 mL, and 1820 +/- 219 mL, respectively) (P < 0.001). Whereas 840 +/- 219 mL of HES60 was needed to maintain target MAP, 1880 +/- 425 mL of LR was needed in the LR60 group, and 4590 +/- 930 mL in the LR80 group (P < 0.001). Lactate blood concentrations were smaller and delivered O(2) higher in the HES60 group (35 +/- 17 mg/dL and 239 +/- 61 mL/min, respectively) in comparison to the LR60 group (89 +/- 18 mg/dL and 140 +/- 48 mL/min, respectively) and the LR80 group (75 +/- 23 mg/dL and 153 +/- 17 mL/min, respectively) (P = 0.02 and P = 0.026). In conclusion, fluid resuscitation during uncontrolled bleeding, to a target MAP of 60 mm Hg, using HES60 resulted in larger oxygen delivery and smaller systemic lactate A resuscitation to a target MAP of 60 or 80 mm Hg using LR.
Fluid resuscitation to a target mean arterial blood pressure of 60 mm Hg during uncontrolled bleeding resulted in larger oxygen delivery and smaller systemic lactate concentrations when hydroxyethyl starch 6% was used, in comparison to lactated Ringer's solution resuscitation to a target mean arterial blood pressure of 60 or 80 mm Hg.
在这项针对犬类的随机对照研究中，我们研究了使用胶体溶液或晶体溶液进行血压靶向液体复苏对全身氧输送和血乳酸浓度的短期影响。将使用6%羟乙基淀粉（HES）使平均动脉血压（MAP）维持在60 mmHg与使用乳酸林格氏液（LR）使MAP维持在60或80 mmHg（分别为LR60和LR80）进行液体复苏相比较。模型是通过动脉导管将血液抽出至MAP为40 mmHg，然后连接到一个系统，在整个研究过程中，只要MAP超过40 mmHg就允许出血。通过持续输注指定的液体替代物将目标MAP维持60分钟。所有15只犬（每组5只）均存活至最后一次测量。LR80组的失血量（2980±503 mL）（所有数值均为平均值±标准差）大于LR60组和HES60组（分别为1800±389 mL和1820±219 mL）（P<0.001）。与LR60组（分别为89±18 mg/dL和140±48 mL/min）和LR80组（分别为75±23 mg/dL和153±17 mL/min）相比，HES60组的血乳酸浓度更低，氧输送量更高（分别为35±17 mg/dL和239±61 mL/min）（P = 0.02和P = 0.026）。总之，在失血性休克期间，使用HES60进行液体复苏使目标MAP达到60 mmHg，与使用LR使目标MAP达到60或80 mmHg相比，可实现更大的氧输送量和更低的全身乳酸水平。
在失血性休克期间，与使用乳酸林格氏液使目标平均动脉血压达到60或80 mmHg进行液体复苏相比，使用6%羟乙基淀粉使目标平均动脉血压达到60 mmHg进行液体复苏可实现更大的氧输送量和更低的全身乳酸浓度。
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