Buchman T G, Menker J B, Lipsett P A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Surg Gynecol Obstet. 1991 Jan;172(1):8-12.
Victims of penetrating trauma often arrive at a trauma center within minutes of sustaining their injury but nevertheless are in a state of deep circulatory shock. Such patients require extensive resuscitative efforts; in particular, some benefit from rapid, massive normothermic fluid resuscitation. During an initial one year period, 153 of 730 patients required immediate operation and, of these, 33 required rapid infusion defined as greater than 5 liters per hour during the first hour. The over-all survival rate of those operated upon was 79 per cent. Encouraged by these data, the rapid infusor (Level 1 H-500) (Level 1, Technologies, Inc.) was modified to further increase normothermic fluid delivery to 500 milliliters per minute. Eleven of the subsequent 205 patients required rapid infusion. There was a statistically significant improvement in clinical flow rates, decrement in resuscitation times and unexpected survival. In particular, the latter group (nine survivors) included four who were clinically dead in the field or on arrival at the trauma center, or both. Rapid infusion of normothermic fluids may be of benefit not only in penetrating trauma but also more generally in the management of massive hemorrhage.
穿透性创伤的受害者通常在受伤后几分钟内就被送往创伤中心，但仍处于深度循环休克状态。这类患者需要大量的复苏措施；特别是，一些患者受益于快速、大量的常温液体复苏。在最初的一年时间里，730名患者中有153名需要立即手术，其中33名需要快速输液，即在第一个小时内每小时输液量超过5升。接受手术患者的总体生存率为79%。受这些数据鼓舞，对快速输液器（一级H-500）（一级技术公司）进行了改进，以使常温液体输送量进一步提高到每分钟500毫升。在随后的205名患者中，有11名需要快速输液。临床输液速度有统计学意义的提高，复苏时间缩短，生存率出人意料。特别是，后一组（9名幸存者）包括4名在现场或到达创伤中心时临床死亡或两者均临床死亡的患者。快速输注常温液体不仅可能有益于穿透性创伤，而且在更广泛的大量出血处理中也可能有益。
