Ribeiro Marcelo Augusto Fontenelle, Epstein Marina Gabrielle, Alves Luciana Daniela Lossurdo de Araujo
Department of Surgery, Universidade Cidade De Sao Paulo Medical School, Sao Paulo, Brazil.
Ulus Travma Acil Cerrahi Derg. 2009 Jul;15(4):311-6.
We aimed to compare different fluids indicated in volume replacement in multiple trauma patients, enlightening the indications, mechanisms of action and side effects. An extensive review of references (indexed journals) between 1997 and 2008 was performed. There is not yet a consensus about which fluids should be used in trauma patients. The systematic reviews available did not show a benefit of colloid solutions over crystalloid fluids. Crystalloids intensify physiological internal dilution, furthered by water migration from interstitial and intracellular spaces into intravascular space due to hypovolemia. The most recent hypertonic solutions used in resuscitation have a large role in expanding blood volume and making blood pressure rise. The hyperoncotic effect of dextran solution produces an initial expansion of intravascular volume that is bigger than the administered volume. Gelatins are no longer used in developed countries due to their insignificant ability regarding volume expansion when compared to crystalloids and the potential risks of anaphylactic reactions. The crystalloids are used more in trauma, even if some authors prefer the use of colloids, which can produce a quicker restoration of the intravascular volume. No convincing evidence shows a clear superiority of colloids over crystalloids for restoration of the volume depletion.
我们旨在比较多种创伤患者容量复苏中使用的不同液体，阐明其适应证、作用机制和副作用。对1997年至2008年期间的参考文献（索引期刊）进行了广泛回顾。对于创伤患者应使用哪种液体尚未达成共识。现有的系统评价未显示胶体溶液优于晶体液。晶体液会加剧生理性内稀释，由于血容量不足，水从间质和细胞内空间迁移至血管内空间会进一步加剧这种情况。复苏中使用的最新高渗溶液在扩充血容量和升高血压方面发挥着重要作用。右旋糖酐溶液的高渗效应会使血管内容量产生比给药量更大的初始扩张。与晶体液相比，明胶在扩容方面作用不显著且存在过敏反应的潜在风险，因此在发达国家已不再使用。晶体液在创伤中使用更为广泛，尽管一些作者更倾向于使用胶体液，因为胶体液能更快恢复血管内容量。没有令人信服的证据表明胶体液在恢复容量耗竭方面明显优于晶体液。
