Horton J W, Walker P B
Department of Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031.
Ann Surg. 1991 Jul;214(1):64-73. doi: 10.1097/00000658-199107000-00011.
This study evaluated resuscitation of endotoxin shock with 7.5% hypertonic saline dextran (HSD 2400 mOsm) by measuring hemodynamic and regional blood flow responses. Endotoxin challenge (1 mg/kg) in adult dogs caused a significant decrease in mean arterial blood pressure (MABP), cardiac output (CO), left ventricular +/- dP/dt max, and regional blood flow (radioactive microspheres). Cardiocirculatory dysfunction and acid-base derangements persisted throughout the experimental period in untreated endotoxin shock (group 1, n = 10). In contrast both regimens of fluid resuscitation (group 2, n = 11: bolus of 4 mL/kg HSD followed by a constant infusion of lactated Ringer's [LR] to maintain MABP and CO at baseline values; group 3, n = 10; LR alone given as described for group 2) improved regional perfusion and corrected acid-base disturbances similarly in all dogs. Hypertonic saline dextran enhanced all indices of cardiac contraction and relaxation more than LR alone. The total volume of LR required to maintain MABP and CO at baseline values was less in the HSD group (59.2 +/- 6.8 mL/kg) than in the LR alone group (158 +/- 16 mL/kg, p = 0.01). The net fluid gain (infused volume minus urine output and normalized for kilogram body weight) was five times greater in the LR (24.8 +/- 6.2 mL/kg) than in the HSD group (4.6 +/- 1.2 mL/kg, p = 0.01). Lung water was similar in all dogs, regardless of the regimen of fluid resuscitation. Hypertonic saline dextran effectively resuscitates endotoxin shock in this canine model.
本研究通过测量血流动力学和局部血流反应，评估了7.5%高渗盐水右旋糖酐（HSD 2400 mOsm）对内毒素休克的复苏效果。成年犬接受内毒素攻击（1 mg/kg）后，平均动脉血压（MABP）、心输出量（CO）、左心室+/- dP/dt max以及局部血流（放射性微球）均显著下降。在未经治疗的内毒素休克中（第1组，n = 10），整个实验期间心脏循环功能障碍和酸碱紊乱持续存在。相比之下，两种液体复苏方案（第2组，n = 11：静脉推注4 mL/kg HSD，随后持续输注乳酸林格氏液[LR]以维持MABP和CO在基线值；第3组，n = 10；按第2组所述单独给予LR）在所有犬中均同样改善了局部灌注并纠正了酸碱紊乱。高渗盐水右旋糖酐比单独使用LR更能增强心脏收缩和舒张的各项指标。维持MABP和CO在基线值所需的LR总体积，HSD组（59.2 +/- 6.8 mL/kg）比单独使用LR组（158 +/- 16 mL/kg，p = 0.01）少。LR组的净液体增加量（输注量减去尿量并按千克体重标准化）（24.8 +/- 6.2 mL/kg）比HSD组（4.6 +/- 1.2 mL/kg，p = 0.01）大五倍。无论液体复苏方案如何，所有犬的肺水含量相似。在该犬模型中，高渗盐水右旋糖酐能有效复苏内毒素休克。
