Halvorsen L, Gunther R A, Dubick M A, Holcroft J W
Department of Surgery, University of California, Davis.
J Trauma. 1991 Jun;31(6):785-93; discussion 793-4. doi: 10.1097/00005373-199106000-00008.
In an effort to find the best hypertonic saline-dextran solution (HSD) for prehospital use, 33 chronically catheterized sheep were bled using a fixed pressure shock model (50 mm Hg x 2 hours) and resuscitated with 4 ml/kg of HSD solution (2-minute bolus). In the first set of experiments colloid was varied and sodium chloride was held constant, as 7.5% NaCl was paired with either 0%, 6%, or 12% dextran 70. A dose-response relationship existed, with cardiac output increasing 20% with each sequential dextran 70 concentration. Mean arterial blood pressure was higher in animals that were resuscitated with either the 7.5% NaCl/6% dextran 70 or 7.5% NaCl/12% dextran 70 solution (p less than 0.05). Using the optimal dextran 70 concentration from the first set of experiments (i.e., 12%), solute was varied in a second set of experiments comparing 0.9%, 3.8%, 7.5%, or 10% NaCl/12% dextran 70. Again, dose-response features were demonstrated, as cardiac output increased as a function of NaCl concentration. However, this response plateaued with the 7.5% NaCl concentration and no advantage was obtained by increasing the NaCl concentration to 10%. We conclude that a 4-ml/kg bolus of 7.5% NaCl/12% dextran 70 solution may be a more effective form of therapy than those previously evaluated. This new solution is now being included in our ongoing clinical trials.
为了找到最适合院前使用的高渗盐水-右旋糖酐溶液（HSD），采用固定压力休克模型（50毫米汞柱×2小时）对33只长期插管的绵羊进行放血，并给予4毫升/千克的HSD溶液（2分钟推注）进行复苏。在第一组实验中，胶体成分不同而氯化钠含量保持恒定，即7.5%氯化钠分别与0%、6%或12%的右旋糖酐70配对。存在剂量反应关系，随着右旋糖酐70浓度的依次增加，心输出量增加20%。用7.5%氯化钠/6%右旋糖酐70或7.5%氯化钠/12%右旋糖酐70溶液复苏的动物平均动脉血压较高（p<0.05）。利用第一组实验中最佳的右旋糖酐70浓度（即12%），在第二组实验中改变溶质成分，比较0.9%、3.8%、7.5%或10%氯化钠/12%右旋糖酐70。同样显示出剂量反应特征，心输出量随氯化钠浓度增加而增加。然而，这种反应在7.5%氯化钠浓度时达到平台期，将氯化钠浓度提高到10%并没有优势。我们得出结论，4毫升/千克推注的7.5%氯化钠/12%右旋糖酐70溶液可能是一种比先前评估的治疗方法更有效的治疗形式。这种新溶液现已纳入我们正在进行的临床试验。
