Younes R N, Aun F, Accioly C Q, Casale L P, Szajnbok I, Birolini D
Department of Surgery, University of São Paulo School of Medicine, Brazil.
Surgery. 1992 Apr;111(4):380-5.
The infusion of small volumes of hypertonic saline solution or hypertonic saline plus dextran 70 is remarkably effective in restoring adequate hemodynamic conditions after hypovolemic shock. This prospective double-blind study compares the immediate hemodynamic effects of a bolus infusion of 7.5% NaCl or 7.5% NaCl plus 6% dextran 70 (both 2400 mOsm/L) in severe hypovolemia.
One hundred five adult patients admitted in hypovolemic shock (systolic blood pressure less than 80 mm Hg) were revived on arrival to the emergency room and administration of a 250 ml intravenous bolus of hypertonic saline solution (n = 35), hypertonic saline plus dextran (n = 35), or isotonic saline solution (n = 35). This infusion was immediately followed by standard crystalloid and blood replacement until systolic pressure reached 100 mm Hg. Mean arterial pressure (MAP) was measured every 5 minutes, and all intravenous infusions were registered. Plasma volume expansion was calculated from plasma protein concentration measurements. Patients were followed up throughout their hospital course, and results of treatment were recorded.
At the end of the infusion period, and 5 and 10 minutes after infusion, MAP was significantly higher in patients receiving either hypertonic solution, compared with the group receiving isotonic solution. All groups showed similar trends toward restoration of hemodynamic parameters thereafter. The calculated plasma volume expansion, immediately after the bolus infusion, was significantly higher (24.1% +/- 1.8% and 24.9% +/- 1.1%) in the hypertonic groups, compared with isotonic groups (7.9% +/- 1.3%). Significantly greater volumes of fluids were required to restore systolic pressure in the patients receiving isotonic saline solution than in the groups receiving hypertonic solution. There were no significant differences between the groups receiving hypertonic solutions. The incidence of complications was low, and the mortality rate was similar in all groups.
Infusion of 250 ml hypertonic saline solution in patients with severe hypovolemia was not related to any complications, nor did it affect mortality rates; it improved MAP significantly, acutely expanded plasma volume by 24%, and reduced significantly the volumes of crystalloids and blood required in their resuscitation.
输注少量高渗盐溶液或高渗盐加右旋糖酐70对恢复低血容量性休克后的充分血流动力学状态非常有效。这项前瞻性双盲研究比较了在严重低血容量情况下快速推注7.5%氯化钠或7.5%氯化钠加6%右旋糖酐70（两者均为2400 mOsm/L）的即时血流动力学效应。
105例低血容量性休克（收缩压低于80 mmHg）的成年患者在抵达急诊室后复苏，并静脉快速推注250 ml高渗盐溶液（n = 35）、高渗盐加右旋糖酐（n = 35）或等渗盐溶液（n = 35）。推注后立即进行标准晶体液和血液补充，直至收缩压达到100 mmHg。每5分钟测量一次平均动脉压（MAP），并记录所有静脉输液情况。根据血浆蛋白浓度测量值计算血浆容量扩充情况。对患者整个住院过程进行随访，并记录治疗结果。
在输注期结束时以及输注后5分钟和10分钟，接受高渗溶液的患者的MAP显著高于接受等渗溶液的组。此后所有组在血流动力学参数恢复方面呈现相似趋势。推注后立即计算的血浆容量扩充，高渗组（24.1%±1.8%和24.9%±1.1%）显著高于等渗组（7.9%±1.3%）。与接受高渗溶液的组相比，接受等渗盐溶液的患者恢复收缩压需要显著更多的液体量。接受高渗溶液的组之间无显著差异。并发症发生率低，所有组的死亡率相似。
对严重低血容量患者输注250 ml高渗盐溶液与任何并发症均无关，也不影响死亡率；它显著改善了MAP，使血浆容量急性扩充24%，并显著减少了复苏所需的晶体液和血液量。
