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小容量高渗盐水与生理盐水联合应用于失血性休克未控制状态的效果

The combined effect of small volume hypertonic saline and normal saline solutions in uncontrolled hemorrhagic shock.

作者信息

Krausz M M, Horn Y, Gross D

机构信息

Department of Surgery B, Hadassah University Hospital, Jerusalem.

出版信息

Surg Gynecol Obstet. 1992 May;174(5):363-8.

PMID:1570612
Abstract

Recently, small volume hypertonic saline solution (HTS) has been suggested for treatment of trauma casualties. Previously, we reported that small volume HTS treatment of uncontrolled hemorrhagic shock (UCHS) leads to increased bleeding, hemodynamic deterioration and early mortality. In the present study, large volume normal saline solution (NS) combined with small volume HTS was used to treat UCHS in rats. The rats were randomly assorted into four groups. Group 1 (n = 9) included rats in which UCHS induced by 12 per cent resection of the tail was untreated; group 2 (n = 8) consisted of those in which UCHS was treated after 15 minutes with 41.5 milliliters per kilogram of sodium chloride, 0.9 per cent (NS); group 3 (n = 7) included rats in which UCHS was treated with 5 milliliters per kilogram sodium chloride, 7.5 per cent (HTS); and group 4 (n = 9) included rats in which UCHS was treated by a combination of HTS and NS. In group 1, resection of the tail was followed by bleeding of 4.9 +/- 0.3 milliliters in 15 minutes, a decrease in mean arterial pressure (MAP) from 105 +/- 5 to 51 +/- 3 torr (p less than 0.001) and pulse rate from 377 +/- 9 to 305 +/- 22 beats per minute (p less than 0.05). Further loss of blood after 30 minutes was 0.5 +/- 0.2 milliliters, MAP rose to 58 +/- 6 torr (p less than 0.05) with the death of two rats. Infusion of NS in group 2 was followed by further bleeding of 3.3 +/- 1.0 milliliters (p less than 0.01) and rise in MAP to 76 +/- 9 after 30 minutes. Infusion of HTS in group 3 was followed by bleeding of 1.9 +/- 0.3 milliliters (p less than 0.05) and fall in MAP to 57 +/- 14 torr (p less than 0.05). Continued loss of blood in this group resulted in further fall in MAP to 36 +/- 11 torr (p less than 0.01) with death of 71 per cent (p less than 0.01) of the rats in four hours. Combined HTS and NS infusion in group 4 was followed by bleeding of 2.0 +/- 0.4 milliliters (p less than 0.05) and an increase in MAP to 93.0 +/- 3.0 torr (p less than 0.005) after 30 minutes with the death of only one animal in four hours. Total loss of blood in the three treated groups was similar and significantly higher than in the untreated group.(ABSTRACT TRUNCATED AT 400 WORDS)

摘要

最近,有人提出用小容量高渗盐溶液(HTS)治疗创伤伤员。此前,我们报道过小容量HTS治疗未控制的失血性休克(UCHS)会导致出血增加、血流动力学恶化和早期死亡。在本研究中,大容量生理盐水(NS)联合小容量HTS用于治疗大鼠UCHS。将大鼠随机分为四组。第1组(n = 9)包括未治疗的通过切除12%尾巴诱导UCHS的大鼠;第2组(n = 8)由在15分钟后用每千克41.5毫升0.9%氯化钠(NS)治疗UCHS的大鼠组成;第3组(n = 7)包括用每千克5毫升7.5%氯化钠(HTS)治疗UCHS的大鼠;第4组(n = 9)包括用HTS和NS联合治疗UCHS的大鼠。在第1组中,尾巴切除后15分钟内出血4.9±0.3毫升,平均动脉压(MAP)从105±5降至51±3托(p<0.001),脉搏率从377±9降至305±22次/分钟(p<0.05)。30分钟后进一步失血0.5±0.2毫升,MAP升至58±6托(p<0.05),有两只大鼠死亡。第2组输注NS后,30分钟内进一步出血3.3±1.0毫升(p<0.01),MAP升至76±9。第3组输注HTS后,出血1.9±0.3毫升(p<0.05),MAP降至57±14托(p<0.05)。该组持续失血导致MAP进一步降至36±11托(p<0.01),4小时内71%的大鼠死亡(p<0.01)。第4组联合输注HTS和NS后,30分钟内出血2.0±0.4毫升(p<0.05),MAP升至93.0±3.0托(p<0.005),4小时内仅1只动物死亡。三个治疗组的总失血量相似,且显著高于未治疗组。(摘要截断于400字)

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