Vassar M J, Perry C A, Holcroft J W
Department of Surgery, University of California, Davis Medical Center, Sacramento 95817.
Arch Surg. 1990 Oct;125(10):1309-15. doi: 10.1001/archsurg.1990.01410220093013.
We evaluated the potential side effects of rapidly infusing 250 mL of either 7.5% sodium chloride or 7.5% sodium chloride per 6% dextran 70, using lactated Ringer's as the control, to 106 critically injured patients in two prospective double-blinded emergency department trials. Eight patients had a significant hyperchloremic acidemia in association with infusion of the hypertonic solutions, but all eight were moribund before infusion and many factors other than hyperchloremia could have contributed to their acidemia. Other blood chemistry changes that might have been associated with the hypertonic solutions, such as hyperosmolality or hypernatremia, were made insignificant by other factors, such as high blood alcohol levels or concomitant administration of sodium bicarbonate. There were no cases of central pontine myelinolysis; bleeding was not potentiated. There was no difficulty with crossmatching of blood. No anaphylactoid reactions occurred. In a setting of limited volume resuscitation, the solutions are likely to have a favorable risk-to-benefit ratio.
在两项前瞻性双盲急诊科试验中，我们将106例重症受伤患者作为研究对象，以乳酸林格氏液作为对照，评估快速输注250毫升7.5%氯化钠溶液或每6%右旋糖酐70中含7.5%氯化钠溶液的潜在副作用。8例患者在输注高渗溶液时出现了明显的高氯性酸血症，但这8例患者在输注前均已奄奄一息，除高氯血症外，许多其他因素可能导致了他们的酸血症。其他可能与高渗溶液相关的血液化学变化，如高渗性或高钠血症，被其他因素（如高血酒精水平或同时使用碳酸氢钠）所掩盖而变得不显著。未发生中枢性桥脑髓鞘溶解病例；出血未加重。血液交叉配血无困难。未发生类过敏反应。在有限容量复苏的情况下，这些溶液可能具有良好的风险效益比。
