Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.
Crit Care Resusc. 2011 Dec;13(4):262-70.
Fluid resuscitation with saline in severe sepsis is controversial. Hypertonic (3%) saline (HTS) may be superior to normal (0.9%) saline (NS).
To compare the effects of HTS and NS on regional blood flow in sepsis.
Randomised controlled crossover large animal study.
University physiology laboratory.
Seven merino cross ewes.
We implanted chronic flow probes around aorta, mesenteric, coronary and renal arteries. Sepsis was induced by the intravenous injection of 3 × 109 colonyforming units of live Escherichia coli. We randomised animals to three groups after onset of sepsis: observation (control), NS (1000 mL over 15 minutes) and HTS (300 mL over 15 minutes).
Continuously measured systemic haemodynamics, organ blood flows and markers of renal function for 210 minutes.
In septic sheep, bolus resuscitation with HTS had similar systemic haemodynamic effects as NS and both increased cardiac output and mesenteric blood flow during the first hour compared with control (P < 0.05). However, this effect dissipated after 60 minutes. These effects were mirrored by effects on mesenteric and coronary blood flow. In contrast, renal blood flow was not changed by either HTS or NS. HTS transiently increased total and mesenteric oxygen delivery (P < 0.05), while NS transiently decreased total and renal oxygen delivery. Urine output and creatinine clearance decreased with sepsis and only transiently increased with NS (P < 0.05) but not HTS.
In gram-negative sepsis, bolus resuscitation with HTS and NS have similar and transient systemic and regional haemodynamic effects, but no effects on renal perfusion and only short-lived effects on renal function. These findings challenge the physiological rationale for fluid bolus resuscitation in sepsis.
在严重脓毒症中，使用生理盐水进行液体复苏存在争议。高渗盐水（HTS）可能优于等渗盐水（NS）。
比较 HTS 和 NS 对脓毒症患者局部血流的影响。
随机对照交叉大型动物研究。
大学生理学实验室。
7 只美利奴杂交母羊。
我们在主动脉、肠系膜、冠状动脉和肾动脉周围植入了慢性血流探头。通过静脉注射 3 × 109 个活大肠杆菌菌落形成单位来诱导脓毒症。在脓毒症发作后，我们将动物随机分为三组：观察（对照）、NS（15 分钟内输注 1000 mL）和 HTS（15 分钟内输注 300 mL）。
连续测量 210 分钟的全身血流动力学、器官血流和肾功能标志物。
在脓毒症绵羊中，HTS 与 NS 相比，在第一个小时内具有相似的全身血流动力学效应，均增加了心输出量和肠系膜血流（P < 0.05）。然而，这种效应在 60 分钟后消失。这种效应反映在肠系膜和冠状动脉血流上。相比之下，HTS 和 NS 均未改变肾血流。HTS 短暂地增加了总肠系膜氧输送（P < 0.05），而 NS 则短暂地降低了总肠系膜氧输送和肾氧输送。尿输出量和肌酐清除率随脓毒症而降低，仅在 NS 短暂增加（P < 0.05）而不是 HTS 增加。
在革兰氏阴性脓毒症中，HTS 和 NS 的冲击式液体复苏具有相似且短暂的全身和局部血流动力学效应，但对肾灌注没有影响，对肾功能只有短暂影响。这些发现挑战了脓毒症中液体冲击式复苏的生理原理。
