Carness Jeffrey M, Russell Jennifer L, M e Lima Rodrigo, Navarro Lais H C, Kramer George C
Department of Anesthesiology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
Mil Med. 2012 Feb;177(2):222-8. doi: 10.7205/milmed-d-11-00195.
The effectiveness of the intraosseous (IO) route for fluid resuscitation remains uncertain. This study compares IO infusion rates and estimated volume expansion using clinically relevant infusion pressures with lactated Ringer's (LR) and hetastarch (HES).
IO needles were placed in the sternum or tibia for infusion of HES and LR in 8 Yorkshire pigs. Pressures were recorded at variable flow rates and linear regression used to identify flow rates at 100 and 400 mm Hg. Volume expansion was calculated for a 10-minute infusion.
Mean LR flow rates (mL x min(-1)) were 24/111 (tibia--100/400 mm Hg) and 8/34 (sternum--100/400 mm Hg). The HES flow rates (mL x min(-1)) of 10/44 (tibia--100/400 mm Hg) and 6/26 (sternum--100/400 mm Hg) were significantly lower or -40% (p < 0.01) of the LR flow rates into the tibia and -70% (p < 0.05) into the sternum. Mean volume expansion (mL) for a 10-min infusion of LR was estimated to be 80/369 (tibia--100/400 mm Hg) and 27/112 (sternum--100/400 mm Hg). In comparison, HES volume expansion was -20% higher for the tibia (p > 0.05) and 110% to 120% higher for the sternum (p < 0.05).
HES flow rates are lower than LR flow rates in the sternum and tibia of swine. Sternal infusion of HES is likely to provide greater estimated intravascular volume expansion than LR despite the lower infusion rates.
骨内（IO）途径用于液体复苏的有效性仍不确定。本研究比较了使用乳酸林格氏液（LR）和羟乙基淀粉（HES）在临床相关输注压力下的IO输注速率和估计的容量扩充情况。
在8只约克夏猪的胸骨或胫骨处放置IO针，用于输注HES和LR。记录不同流速下的压力，并使用线性回归确定100和400毫米汞柱时的流速。计算10分钟输注的容量扩充情况。
LR的平均流速（毫升×分钟⁻¹）在胫骨处为24/111（100/400毫米汞柱），在胸骨处为8/34（100/400毫米汞柱）。HES的流速（毫升×分钟⁻¹）在胫骨处为10/44（100/400毫米汞柱），在胸骨处为6/26（1图100/400毫米汞柱），显著低于LR流速，在胫骨处低40%（p < 0.01），在胸骨处低70%（p < 0.05）。10分钟输注LR的平均容量扩充（毫升）估计在胫骨处为80/369（100/400毫米汞柱），在胸骨处为27/112（100/400毫米汞柱）。相比之下，HES在胫骨处的容量扩充高20%（p > 0.05），在胸骨处高110%至120%（p < 0.05）。
在猪的胸骨和胫骨中，HES的流速低于LR流速。尽管输注速率较低，但胸骨输注HES可能比LR提供更大的估计血管内容量扩充。
