Departamento de Cirurgia, Divisão de Cirurgia Geral do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil.
Clinics (Sao Paulo). 2010;65(1):67-78. doi: 10.1590/S1807-59322010000100011.
This study evaluated retroperitoneal hematomas produced by bilateral injury of iliac arteries (uncontrolled hemorrhage), blood volume loss, transcapillary refill, the effects of volume replacement on retroperitoneal bleeding and the hemodynamic changes with and without treatment.
Initial blood volume was determined with Tc(99m)-labelled red cells, and bleeding was evaluated by means of a portable scintillation camera positioned over the abdomen. Previously splenectomized mongrel dogs (16.8 +/- 2.2 kg) were submitted to hemorrhage for 30 minutes and randomized into three groups: I - no treatment (n=7); II - treatment with 32 mL/kg of Lactated Ringer's for three to five minutes (n=7); and III - treatment with 4 mL/kg of 7.5% NaCl plus 6.0% dextran 70 for three to five minutes (n=7). They were studied for an additional 45 minutes.
Volume replacement produced transitory recovery in hemodynamic variables, including mean pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac index, with significant increase in dogs treated with 32 mL/kg of Lactated Ringer's and 7.5% NaCl plus 6.0% dextran 70 (p<0.001, against no treatment), along with a decrease (p<0.001) in the systemic vascular resistance index. Groups II and III had significant initial decreases in hematocrit and hemoglobin. The treated dogs (groups II and III) presented rebleeding, which was greater during treatment with 32 mL/kg of Lactated Ringer's (group II).
Despite the rebleeding observed in treated groups, the utilization of hypertonic saline solution with dextran proved to be effective in the initial reanimation, producing evident transcapillary refill, while the Lactated Ringer's solution produced capillary extravasation and was ineffective in the initial volume replacement in this model of uncontrolled hemorrhage.
本研究评估了双侧髂动脉损伤（未控制出血）导致的腹膜后血肿、失血量、毛细血管再充盈、容量替代对腹膜后出血的影响以及有和无治疗时的血流动力学变化。
通过 Tc(99m)-标记的红细胞测定初始血容量，并通过放置在腹部上方的便携式闪烁相机评估出血情况。先前进行脾切除术的杂种犬（16.8±2.2kg）接受 30 分钟的出血，并随机分为三组：I-无治疗（n=7）；II-用 32mL/kg 的乳酸林格氏液治疗 3 到 5 分钟（n=7）；III-用 4mL/kg 的 7.5%生理盐水加 6.0%右旋糖酐 70 治疗 3 到 5 分钟（n=7）。它们被研究了另外 45 分钟。
容量替代使包括肺动脉压、肺毛细血管楔压和心指数在内的血流动力学变量暂时恢复，用 32mL/kg 的乳酸林格氏液和 7.5%生理盐水加 6.0%右旋糖酐 70 治疗的狗的指数显著增加（p<0.001，与无治疗相比），同时全身血管阻力指数降低（p<0.001）。第 II 和第 III 组的红细胞压积和血红蛋白初始时显著降低。接受治疗的狗（第 II 和第 III 组）出现再出血，用 32mL/kg 的乳酸林格氏液治疗时再出血更多（第 II 组）。
尽管在治疗组中观察到再出血，但用高渗盐水加右旋糖酐的应用在初始复苏中被证明是有效的，产生明显的毛细血管再充盈，而乳酸林格氏液导致毛细血管外渗，在这种未控制出血模型中初始容量替代时无效。
