Reed R L, Johnston T D, Chen Y, Fischer R P
Department of Surgery, University of Texas Medical School, Houston 77030.
J Trauma. 1991 Jan;31(1):8-14. doi: 10.1097/00005373-199101000-00002.
Hypertonic (7.5%) saline (HS) is advocated for resuscitation of injured and burned patients. Recent animal studies indicate that HS increases bleeding during uncontrolled hemorrhage, although the mechanisms for this are unclear. To investigate potential anticoagulant effects of HS (without dextran), normal human plasma was serially diluted with either HS or normal (0.9%) saline (NS). Prothrombin times (PT), activated partial thromboplastin times (APTT), and platelet aggregation studies were performed. Significant (p less than 0.05) deteriorations in clotting tests and platelet aggregation developed when 10% or more of normal plasma was replaced by HS, whereas there was no effect from similar NS dilutions. Strong correlations were observed between clotting test changes and sodium concentrations (R2 greater than 0.80, p less than 0.0001). Thus, HS exhibits anticoagulant activity, but not at the usual small volumes necessary to produce hemodynamic improvement. Nevertheless, the anticoagulant effect may be more pronounced with ongoing clotting factor losses or with the addition of dextran.
高渗（7.5%）盐水（HS）被推荐用于受伤和烧伤患者的复苏。最近的动物研究表明，HS会增加未控制出血期间的出血量，尽管其机制尚不清楚。为了研究HS（不含右旋糖酐）的潜在抗凝作用，用人血浆分别用HS或等渗（0.9%）盐水（NS）进行系列稀释。进行了凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和血小板聚集研究。当正常血浆的10%或更多被HS替代时，凝血试验和血小板聚集出现显著（p<0.05）恶化，而类似的NS稀释则没有影响。在凝血试验变化和钠浓度之间观察到强相关性（R2>0.80，p<0.0001）。因此，HS具有抗凝活性，但在产生血流动力学改善所需的通常小剂量时不具有。然而，随着凝血因子持续流失或添加右旋糖酐，抗凝作用可能会更明显。
