Rocha-e-Silva Mauricio, Poli de Figueiredo Luiz F
Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2005 Apr;60(2):159-72. doi: 10.1590/s1807-59322005000200013. Epub 2005 Apr 26.
Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.
小容量高渗复苏是一种相对较新的休克治疗概念方法。它最初基于这样一种理念，即通过利用渗透作用，给予相对少量的液体就能实现相对较大的血容量扩充。很快人们就认识到，高渗的生理血管舒张特性是小容量复苏的一个有益副产品，因为它能诱导先前缺血区域的再灌注，尽管这种效应会受到缺血再灌注过程有害影响的干扰。随后的研究揭示了高渗复苏的一些先前未被怀疑的特性，其中包括纠正内皮细胞和红细胞水肿，这对毛细血管血流有重大影响。高渗对免疫系统的一整套作用正逐渐被发现，但这些观察结果对临床情况的全部意义仍在研究中。尽管有人对在出血未得到控制的情况下其安全性提出异议，但小容量休克复苏目前在世界某些地区的临床中仍有应用。这些异议主要源于实验研究，但几乎没有迹象表明它们可能具有实际临床意义。本综述试图涵盖该领域早期和近期的发展情况。
