Pascual J M, Watson J C, Runyon A E, Wade C E, Kramer G C
Division of Military Trauma Research, Letterman Army Institute of Research, Presidio of San Francisco, CA 94129-6800.
Crit Care Med. 1992 Feb;20(2):200-10.
We compared a hypertonic saline-dextran solution (7.5% NaCl/6% dextran-70) with 0.9% NaCl (normal saline) for treatment of intraoperative hypovolemia. Fourteen anesthetized pigs (mean weight 36.3 +/- 2.1 kg) underwent thoracotomy, followed by hemorrhage for 1 hr to reduce mean arterial pressure to 45 mm Hg. A continuous infusion of either solution was then initiated and the flow rate was adjusted to restore and maintain aortic blood flow at baseline levels for 2 hrs.
Full resuscitation to initial values of aortic blood flow was achieved with both regimens, but the normal saline group required substantially larger volumes and sodium loads to maintain stable hemodynamic values. Normal saline resuscitation produced increases in right ventricular preload (central venous pressure) and afterload (pulmonary arterial pressure and pulmonary vascular resistance), resulting in increased right ventricular work.
Hypertonic saline-dextran solution resuscitation of intraoperative hypovolemia is performed effectively with smaller fluid and sodium loads, and is devoid of the deleterious effects associated with fluid accumulation induced by a conventional isotonic solution regimen.
我们比较了高渗盐水-右旋糖酐溶液（7.5%氯化钠/6%右旋糖酐-70）与0.9%氯化钠（生理盐水）治疗术中低血容量的效果。14只麻醉猪（平均体重36.3±2.1千克）接受开胸手术，随后出血1小时，使平均动脉压降至45毫米汞柱。然后开始持续输注其中一种溶液，并调整流速以恢复并维持主动脉血流在基线水平2小时。
两种方案均使主动脉血流完全复苏至初始值，但生理盐水组需要大量更多的液体量和钠负荷来维持稳定的血流动力学值。生理盐水复苏导致右心室前负荷（中心静脉压）和后负荷（肺动脉压和肺血管阻力）增加，从而使右心室做功增加。
高渗盐水-右旋糖酐溶液复苏术中低血容量有效，所需液体和钠负荷较小，且无传统等渗溶液方案引起的液体蓄积相关的有害影响。
