Sondeen J L, Gonzaludo G A, Loveday J A, Rodkey W G, Wade C E
Division of Military Trauma Research, Letterman Army Institute of Research, Presidio of San Francisco, CA 94129-6800.
Resuscitation. 1990 Dec;20(3):231-41. doi: 10.1016/0300-9572(90)90006-z.
This study was performed to determine whether resuscitation with a single bolus of 7.5% NaCl/6% Dextran 70 (hypertonic saline/Dextran, HSD) could restore renal function following hemorrhage. Chronically instrumented, conscious pigs were hemorrhaged 28 ml/kg. This level of hemorrhage reduced mean arterial pressure (MAP) and cardiac output (CO) to nearly half, renal blood flow (RBF) to approximately 25%, and glomerular filtration rate (GFR) and urine flow (V) to less than 10% of their initial values. A single, 4 ml/kg bolus injection of HSD increased MAP and RBF to approximately 80% of baseline values and restored CO and GFR to levels which were significantly different from control values. These improvements were sustained for 2 h with no further treatment. Urine flow transiently increased although not to pre-hemorrhage values, and then subsided. Plasma osmolality increased from 275 to 282 mOsm/kg H2O, and plasma sodium increased from 141 to 149 mEq/l. Recovery following administration of an equal volume of normal saline was significantly less for all variables. Euvolemic animals showed no response in MAP, CO, RBF, or GFR when treated with HSD although V, osmotic and sodium excretion increased. These results demonstrate that resuscitation with HSD following hemorrhage not only restores MAP and CO, but maintains renal function as well.
本研究旨在确定单次推注7.5%氯化钠/6%右旋糖酐70（高渗盐水/右旋糖酐，HSD）进行复苏是否能在出血后恢复肾功能。对长期植入监测装置的清醒猪进行28 ml/kg的放血。这种放血水平使平均动脉压（MAP）和心输出量（CO）降至近一半，肾血流量（RBF）降至约25%，肾小球滤过率（GFR）和尿流量（V）降至初始值的不到10%。单次4 ml/kg推注HSD可使MAP和RBF增加至基线值的约80%，并使CO和GFR恢复到与对照值有显著差异的水平。在未进行进一步治疗的情况下，这些改善持续了2小时。尿流量短暂增加，尽管未达到出血前的值，然后又下降。血浆渗透压从275 mOsm/kg H2O增加到282 mOsm/kg H2O，血浆钠从141 mEq/l增加到149 mEq/l。给予等体积生理盐水后的恢复情况在所有变量上均明显较差。血容量正常的动物在接受HSD治疗时，MAP、CO、RBF或GFR均无反应，尽管V、渗透压和钠排泄增加。这些结果表明，出血后用HSD进行复苏不仅能恢复MAP和CO，还能维持肾功能。
