Vassar M J, Perry C A, Gannaway W L, Holcroft J W
Department of Surgery, University of California Davis Medical Center, Sacramento.
Arch Surg. 1991 Sep;126(9):1065-72. doi: 10.1001/archsurg.1991.01410330019002.
To evaluate the use of hypertonic saline/dextran solutions in the prehospital resuscitation of severely injured patients, we administered 250 mL of either 7.5% sodium chloride/dextran 70 (HSD) (n = 83) or lactated Ringer's solution (n = 83), followed by conventional isotonic fluids, to 166 trauma patients with systolic blood pressures less than or equal to 100 mm Hg, in a prospective, randomized, double-blinded clinical trial. Patients in the sodium chloride/dextran 70 group required less fluid before hospitalization and arrived in the emergency department with higher systolic blood pressures than patients in the lactated Ringer's solution group. The rate of survival to hospital discharge for the entire cohort was 64% for patients in the sodium chloride/dextran 70 group vs 59% for patients in the lactated Ringer's solution group. The rate of survival to hospital discharge for the patients with severe head injuries was 32% for the sodium chloride/dextran 70 group vs 16% for the lactated Ringer's solution group. Actuarial survival for patients with severe head injuries in the sodium chloride/dextran 70 group compared with patients with severe head injuries in the lactated Ringer's solution group did not quite reach statistical significance. There were no adverse side effects associated with sodium chloride/dextran 70 administration. Administration of small volumes of sodium chloride/dextran 70 before hospitalization increased the blood pressure of severely injured patients more effectively than did lactated Ringer's solution and showed tendencies toward improving survival in the patients with severe head injuries.
为评估高渗盐水/右旋糖酐溶液在重伤患者院前复苏中的应用，我们在一项前瞻性、随机、双盲临床试验中，对166例收缩压小于或等于100mmHg的创伤患者，给予250ml的7.5%氯化钠/右旋糖酐70（HSD）（n = 83）或乳酸林格氏液（n = 83），随后给予常规等渗液体。与乳酸林格氏液组患者相比，氯化钠/右旋糖酐70组患者在住院前所需液体较少，到达急诊科时收缩压较高。整个队列中，氯化钠/右旋糖酐70组患者出院生存率为64%，乳酸林格氏液组为59%。重度颅脑损伤患者中，氯化钠/右旋糖酐70组出院生存率为32%，乳酸林格氏液组为16%。氯化钠/右旋糖酐70组重度颅脑损伤患者的精算生存率与乳酸林格氏液组重度颅脑损伤患者相比，未达到统计学显著性。氯化钠/右旋糖酐70给药未出现不良副作用。住院前给予小剂量氯化钠/右旋糖酐70比乳酸林格氏液更有效地提高了重伤患者的血压，且显示出改善重度颅脑损伤患者生存率的趋势。
