Prough D S, Whitley J M, Taylor C L, Deal D D, DeWitt D S
Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, NC 27103.
Crit Care Med. 1991 Mar;19(3):364-72. doi: 10.1097/00003246-199103000-00015.
This study compared canine systemic hemodynamics and organ blood flow (radioactive microsphere technique) after resuscitation with 0.8% saline (Na+ 137 mEq/L), 7.2% hypertonic saline (Na+ 1233 mEq/L), 20% hydroxyethyl starch in 0.8% saline, or 20% hydroxyethyl starch in 7.2% saline, each in a volume approximating 15% of shed blood volume. Twenty-four endotracheally intubated mongrel dogs (18 to 24 kg) underwent a 30-min period of hemorrhagic shock, from time 0 to 30 min into the shock period, followed by fluid resuscitation. Data were collected at baseline, 15 min into the shock period, immediately after fluid infusion, 5 min after the beginning of resuscitation, and at 60-min intervals for 2 hr, (65 min after the beginning of resuscitation, and 125 min after the beginning of resuscitation). The animals received one of four randomly assigned iv resuscitation fluids: saline (54 mL/kg), hypertonic saline (6.0 mL/kg), hydroxyethel starch (6.0 mL/kg) or hypertonic saline/hydroxyethyl starch (6.0 mL/kg).
Mean arterial pressure increased in all groups after resuscitation. Cardiac output increased with resuscitation in all groups, exceeding baseline in the saline and hypertonic saline/hydroxyethyl starch groups (p less than .05 compared with hypertonic saline or hydroxyethyl starch). Sixty-five minutes after the beginning of resuscitation, cardiac output was significantly (p less than .05) greater in either of the two colloid-containing groups than in the hypertonic saline group. After resuscitation, hypertonic saline and hydroxyethyl starch produced minimal improvements in hepatic arterial flow, hypertonic saline/hydroxyethyl starch increased hepatic arterial flow to near baseline levels, and saline markedly increased hepatic arterial flow to levels exceeding baseline (p less than .05, saline vs. hydroxyethyl starch). One hundred twenty-five minutes after the beginning of resuscitation, hepatic arterial flow had decreased in all groups; hepatic arterial flow in the hypertonic saline group had decreased to levels comparable with those during shock. Myocardial, renal, and brain blood flow were not significantly different between groups.
Small-volume resuscitation with the combination of hypertonic saline/hydroxyethyl starch is comparable with much larger volumes of 0.8% saline, and is equal to hypertonic saline or hydroxyethyl starch in the ability to restore and sustain BP and improve organ blood flow after resuscitation from hemorrhagic shock.
本研究比较了用0.8%生理盐水（钠含量137 mEq/L）、7.2%高渗盐水（钠含量1233 mEq/L）、0.8%生理盐水中的20%羟乙基淀粉或7.2%生理盐水中的20%羟乙基淀粉进行复苏后犬的全身血流动力学和器官血流情况（放射性微球技术），每种液体的用量均约为失血量的15%。24只经气管插管的杂种犬（体重18至24千克）经历了30分钟的失血性休克，从休克期开始的0至30分钟，随后进行液体复苏。在基线、休克期15分钟、液体输注后即刻、复苏开始后5分钟以及复苏开始后60分钟间隔（复苏开始后第65分钟和第125分钟）收集数据。动物随机接受四种静脉复苏液体之一：生理盐水（54 mL/kg）高渗盐水（6.0 mL/kg）、羟乙基淀粉（6.0 mL/kg）或高渗盐水/羟乙基淀粉（6.0 mL/kg）。
复苏后所有组的平均动脉压均升高。所有组复苏后心输出量均增加，生理盐水组和高渗盐水/羟乙基淀粉组的心输出量超过基线水平（与高渗盐水组或羟乙基淀粉组相比，p<0.05）。复苏开始后65分钟，含胶体的两组中的任何一组的心输出量均显著高于高渗盐水组（p<0.05）。复苏后，高渗盐水和羟乙基淀粉对肝动脉血流的改善最小，高渗盐水/羟乙基淀粉使肝动脉血流增加至接近基线水平，而生理盐水使肝动脉血流显著增加至超过基线水平（生理盐水组与羟乙基淀粉组相比，p<0.05）。复苏开始后125分钟，所有组的肝动脉血流均下降；高渗盐水组的肝动脉血流已降至与休克期间相当的水平。各组间心肌、肾和脑血流无显著差异。
高渗盐水/羟乙基淀粉联合小容量复苏与大量的0.8%生理盐水复苏效果相当，在失血性休克复苏后恢复和维持血压以及改善器官血流方面，其能力等同于高渗盐水或羟乙基淀粉。
