DuBose Joseph J, Kobayashi Leslie, Lozornio Alfredo, Teixeira Pedro, Inaba Kenji, Lam Lydia, Talving Peep, Branco Bernardino, Demetriades Demetrios, Rhee Peter
Division of Trauma, University of Southern California Medical Center, Los Angeles County, Los Angeles, California, USA.
J Trauma. 2010 May;68(5):1172-7. doi: 10.1097/TA.0b013e3181d76d40.
Published experience of hypertonic saline (HTS) use in resuscitation has described the use of commercially unavailable 7.5% solutions. The purpose of this study was to compare our experience with the administration of commercially available 5% HTS solution with that of well-matched controls who did not receive HTS.
Prospective observational study of 51 trauma patients receiving 500 mL of 5% HTS during initial resuscitation. Patients who received HTS were 1:2 matched using age, gender, Injury Severity Score, Coma Score, Head Abbreviated Injury Scale, and injury mechanism to trauma patients who did not receive HTS. The laboratory values and outcomes of the two groups were compared.
Patients receiving HTS demonstrated no difference from the matched cohort in mean pH, international normalized ratio, or p/f ratios at 8 hours or 24 hours. The mean serum sodium of the HTS group was higher than controls at 8 hours (143.1 vs. 150.1 mg/dL, p < 0.001) and remained significantly more increased for 3 days without any adverse sequelae related to hypernatremia. No difference in mortality was noted between the two groups. A trend in decreased mortality was observed in patients with Coma Score <or=8 and Head Abbreviated Injury Scale score >or=3 (25.0% vs. 42.5%). The mean ventilator days were 7.3 for HTS group and 9.2 for the non-HTS group.
Although serum sodium remained increased for several days after HTS administration, no adverse sequelae as a result of hypernatremia resulted. Commercially available 5% HTS solution is safe for use in the resuscitation of trauma patients and may improve outcomes in a selected subset of patients with head injury.
已发表的关于高渗盐水（HTS）用于复苏的经验描述了使用市售不可得的7.5%溶液。本研究的目的是将我们使用市售5% HTS溶液的经验与未接受HTS的匹配良好的对照组进行比较。
对51例在初始复苏期间接受500 mL 5% HTS的创伤患者进行前瞻性观察研究。接受HTS的患者与未接受HTS的创伤患者按年龄、性别、损伤严重程度评分、昏迷评分、头部简明损伤量表和损伤机制进行1:2匹配。比较两组的实验室值和结果。
接受HTS的患者在8小时或24小时时的平均pH值（酸碱度）、国际标准化比值或p/f比值与匹配队列无差异。HTS组在8小时时的平均血清钠高于对照组（143.1对150.1 mg/dL，p<0.001），并且在3天内仍显著升高，且无任何与高钠血症相关的不良后遗症。两组之间的死亡率无差异。在昏迷评分≤8且头部简明损伤量表评分≥3的患者中观察到死亡率下降的趋势（25.0%对42.5%）。HTS组的平均呼吸机使用天数为7.3天，非HTS组为9.2天。
尽管HTS给药后血清钠持续升高数天，但未导致高钠血症的不良后遗症。市售5% HTS溶液用于创伤患者的复苏是安全的，并且可能改善部分头部受伤患者的预后。
