Varicoda Edson Y, Poli de Figueiredo Luiz F, Cruz Ruy J, Silva Leonardo E, Rocha e Silva Mauricio
Research Division, University of São Paulo Medical School, São Paulo, Brazil.
J Trauma. 2003 Jul;55(1):112-7. doi: 10.1097/01.TA.0000074350.61500.E0.
It has been suggested that fluid resuscitation for the prehospital management of hypotensive trauma victims increases bleeding. In a model of uncontrolled hemorrhage induced by complete splenic laceration with a hilar vascular injury, we hypothesized that small-volume hypertonic saline or large-volume lactated Ringer's solution may provide sustained hemodynamic benefits despite promoting increases in intra-abdominal bleeding.
Forty anesthetized, spontaneously breathing dogs (18 +/- 1 kg) underwent laparotomy. A suture line was placed around the spleen to produce a splenic rupture with hilar vascular injury by pulling the exteriorized lines after incision closure. Intra-abdominal blood loss was measured directly, immediately after the animal was killed. Dogs were randomly assigned to four groups (n = 10 per group): Untreated controls were killed 20 (CT20) or 40 (CT40) minutes after splenic rupture to measure blood loss directly. Treatment groups received (20 minutes after spleen rupture) lactated Ringer's (LR), 33 mL/kg over 15 minutes, or 7.5% NaCl/6% dextran 70 (HSD), 4 mL/kg over 4 minutes. Blood loss was measured 40 minutes after spleen rupture.
Mean arterial pressure dropped from an average value of 103 +/- 3 mm Hg to 67 +/- 5 mm Hg during the first 20 minutes and was partially restored afterward in all groups, with no significant differences between them. No resuscitation was associated with low cardiac output, whereas HSD restored and LR overshot baseline cardiac output. Intra-abdominal blood loss was 30 +/- 4, 38 +/- 4, 43 +/- 5, and 42 +/- 5 mL/kg for groups CT20, CT40, HSD, and LR, respectively, with no statistical significance between groups.
No-fluid resuscitation in uncontrolled hemorrhage from splenic rupture resulted in a low-flow state, whereas resuscitation with small volumes of HSD or large volumes of LR produced hemodynamic benefits without significant increases in bleeding.
有人提出，对低血压创伤患者进行院前液体复苏会增加出血。在一种通过完全脾破裂伴肝门血管损伤诱导的非控制性出血模型中，我们假设，尽管会促使腹腔内出血增加，但小剂量高渗盐水或大剂量乳酸林格液可能会带来持续的血流动力学益处。
40只麻醉状态下自主呼吸的犬（体重18±1千克）接受剖腹手术。在脾脏周围放置缝线，在切口闭合后牵拉外置缝线以造成伴有肝门血管损伤的脾破裂。在动物处死后立即直接测量腹腔内失血量。犬被随机分为四组（每组n = 10）：未治疗的对照组在脾破裂后20（CT20）或40（CT40）分钟处死，以直接测量失血量。治疗组在脾破裂后20分钟接受乳酸林格液（LR），15分钟内输注33毫升/千克，或7.5%氯化钠/6%右旋糖酐70（HSD），4分钟内输注4毫升/千克。在脾破裂后40分钟测量失血量。
在前20分钟内，平均动脉压从平均103±3毫米汞柱降至67±5毫米汞柱，之后所有组均部分恢复，各组之间无显著差异。未进行复苏与低心输出量相关，而HSD使心输出量恢复，LR则超过基线心输出量。CT20组、CT40组、HSD组和LR组的腹腔内失血量分别为30±4、38±4、43±5和42±5毫升/千克，各组之间无统计学意义。
脾破裂非控制性出血时不进行液体复苏会导致低流量状态，而小剂量HSD或大剂量LR复苏可带来血流动力学益处，且出血无显著增加。
