Wade C E, Hannon J P, Bossone C A, Hunt M M
Letterman Army Institute of Research, Division of Military Trauma Research, Presidio of San Francisco, CA 94129-6800.
Resuscitation. 1990 Aug;20(1):49-56. doi: 10.1016/0300-9572(90)90086-t.
We compared the effectiveness of intravenously administering hypertonic saline/dextran (HSD; 7.5% NaCl in 6% Dextran-70, n = 6) to hypertonic saline (HS) alone (7.5% NaCl, n = 8) in rectifying detrimental effects of hemorrhage on cardiovascular function. Chronically instrumented conscious swine were hemorrhaged 37.5 ml/kg over 60 min. If untreated, this model is 100% lethal within 60 min. Swine received HSD or HS at 4 ml/kg. Functional variables were measured before and at 5, 15, and 30 min following treatment. HSD produced a significantly greater plasma volume expansion than HS alone (13.6 compared to 9.9 ml/kg). Over 30 min expansion was sustained in pigs receiving HSD but pigs receiving HS regressed. Cardiac index (CI) increased for both treatments, being greater with HSD, 104 ml/kg/min, compared to HS alone, 46 ml/kg/min. Neither group fully sustained these elevated values post-treatment, but remained consistently greater than values after hemorrhage; however, the difference in CI between treatments was maintained. Oxygen delivery showed a trend similar to that of CI. We conclude that resuscitation with HSD is superior to HS in improving cardiovascular function over the first 30 min after hemorrhage.
我们比较了静脉注射高渗盐水/右旋糖酐（HSD；7.5%氯化钠溶于6%右旋糖酐-70，n = 6）与单独使用高渗盐水（HS，7.5%氯化钠，n = 8）纠正出血对心血管功能有害影响的效果。对长期植入监测仪器的清醒猪在60分钟内失血37.5 ml/kg。如果不进行治疗，该模型在60分钟内致死率为100%。猪按4 ml/kg的剂量接受HSD或HS治疗。在治疗前以及治疗后5、15和30分钟测量功能变量。HSD产生的血浆容量扩充显著大于单独使用HS（分别为13.6和9.9 ml/kg）。接受HSD治疗的猪在30分钟内血浆容量扩充得以维持，而接受HS治疗的猪血浆容量扩充则出现回落。两种治疗方法的心脏指数（CI）均升高，HSD组更高，为104 ml/kg/min，而单独使用HS组为46 ml/kg/min。治疗后两组均未完全维持这些升高的值，但仍始终高于出血后的数值；然而，两种治疗方法之间CI的差异得以维持。氧输送呈现出与CI相似的趋势。我们得出结论，在出血后的前30分钟，用HSD复苏在改善心血管功能方面优于HS。
