Phillips Charles R, Vinecore Kevin, Hagg Daniel S, Sawai Rebecca S, Differding Jerome A, Watters Jennifer M, Schreiber Martin A
Department of Medicine, Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Physicians Pavilion, Suite 340, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
Crit Care. 2009;13(2):R30. doi: 10.1186/cc7736. Epub 2009 Mar 4.
Pulmonary oedema and impairment of oxygenation are reported as common consequences of haemorrhagic shock and resuscitation (HSR). Surprisingly, there is little information in the literature examining differences in crystalloid type during the early phase of HSR regarding the development of pulmonary oedema, the impact on oxygenation and the haemodynamic response. These experiments were designed to determine if differences exist because of crystalloid fluid type in the development of oedema, the impact on oxygenation and the haemodynamic response to fluid administration in early HSR.
Twenty anaesthetised swine underwent a grade V liver injury and bled without resuscitation for 30 minutes. The animals were randomised to receive, in a blinded fashion, either normal saline (NS; n = 10) or lactated Ringer's solution (LR; n = 10). They were then resuscitated with study fluid to, and maintained at, the preinjury mean arterial pressure (MAP) for 90 minutes.
Extravascular lung water index (EVLWI) began to increase immediately with resuscitation with both fluid types, increasing earlier and to a greater degree with NS. A 1 ml/kg increase in EVLWI from baseline occurred after administartion of (mean +/- standard error of the mean) 68.6 +/- 5.2 ml/kg of normal saline and 81.3 +/- 8.7 ml/kg of LR (P = 0.027). After 150 ml/kg of fluid, EVLWI increased from 9.5 +/- 0.3 ml/kg to 11.4 +/- 0.3 ml/kg NS and from 9.3 +/- 0.2 ml/kg to 10.8 +/- 0.3 ml/kg LR (P = 0.035). Despite this, oxygenation was not significantly impacted (Delta partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) <or= 100) until approximately 250 ml/kg of either fluid had been administered. Animals resuscitated with NS were more acidaemic (with lower lactates), pH 7.17 +/- 0.03 NS vs. 7.41 +/- 0.02 LR (P < 0.001).
This study suggests that early resuscitation of haemorrhagic shock with NS or LR has little impact on oxygenation when resuscitation volume is less than 250 ml/kg. LR has more favourable effects than NS on EVLWI, pH and blood pressure but not on oxygenation.
肺水肿和氧合功能受损被报道为失血性休克及复苏（HSR）的常见后果。令人惊讶的是，文献中几乎没有关于HSR早期阶段不同晶体液类型在肺水肿发展、对氧合的影响及血流动力学反应方面差异的信息。这些实验旨在确定在HSR早期，晶体液类型的不同是否会在水肿发展、对氧合的影响以及液体输注的血流动力学反应方面存在差异。
20只麻醉猪遭受V级肝损伤，不放血复苏30分钟。动物被随机分组，以盲法接受生理盐水（NS；n = 10）或乳酸林格氏液（LR；n = 10）。然后用研究液体复苏至伤前平均动脉压（MAP）并维持90分钟。
两种液体复苏后血管外肺水指数（EVLWI）立即开始升高，NS组升高更早且幅度更大。给予（平均±平均标准误）68.6±5.2 ml/kg生理盐水和81.3±8.7 ml/kg LR后，EVLWI较基线升高1 ml/kg（P = 0.027）。给予150 ml/kg液体后，NS组EVLWI从9.5±0.3 ml/kg升至11.4±0.3 ml/kg，LR组从9.3±0.2 ml/kg升至10.8±0.3 ml/kg（P = 0.035）。尽管如此，在输注约250 ml/kg任何一种液体之前，氧合功能并未受到显著影响（动脉血氧分压（PaO2）/吸入氧分数（FiO2）的变化≤100）。用NS复苏的动物更酸血症（乳酸水平较低），NS组pH值为7.17±0.03，LR组为7.41±0.02（P < 0.001）。
本研究表明，当复苏量小于250 ml/kg时，用NS或LR对失血性休克进行早期复苏对氧合功能影响不大。LR在EVLWI、pH值和血压方面比NS有更有利影响，但对氧合功能无影响。
