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在低血容量性休克的婴儿动物模型中比较生理盐水、高渗盐水和高渗盐水胶体复苏液。

Comparison of normal saline, hypertonic saline and hypertonic saline colloid resuscitation fluids in an infant animal model of hypovolemic shock.

机构信息

Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain.

出版信息

Resuscitation. 2012 Sep;83(9):1159-65. doi: 10.1016/j.resuscitation.2012.02.003. Epub 2012 Mar 3.

Abstract

PURPOSE

Incorrect resuscitation after hypovolemic shock is a major contributor to preventable pediatric death. Several studies have demonstrated that small volumes of hypertonic or hypertonic-hyperoncotic saline can be an effective initial resuscitation solution. However, there are no pediatric studies to recommend their use. The aim of this study is to determine if in an infant animal model of hemorrhagic shock, the use of hypertonic fluids, as opposed to isotonic crystalloids, would improve global hemodynamic and perfusion parameters.

METHODS

Experimental, randomized animal study including thirty-four 2-to-3-month-old piglets. 30 min after controlled 30 mL kg(-1) bleed, pigs were randomized to receive either normal saline (NS) 30 mL kg(-1) (n=11), 3% hypertonic saline (HS) 15 mL kg(-1) (n=12), or 5% albumin plus 3% hypertonic saline (AHS) 15 mL kg(-1) (n=11).

RESULTS

High baseline heart rate (HR) and low mean arterial pressure (MAP), cardiac index (CI), brain tissue oxygenation index (bTOI), and lactate were recorded 30 min after volume withdrawal, with no significant differences between groups. Thirty minutes after volume replacement there were no significant differences between groups for HR (NS, 188±14; HS, 184±14; AHS, 151±14 bpm); MAP (NS, 80±7; HS, 86±7; AHS, 87±7 mmHg); CI (NS, 4.1±0.4; HS, 3.9±0.4; AHS, 5.1±0.4 mL min(-1)m(-2)); lactate (NS, 2.8±0.7; HS, 2.3±0.6; AHS, 2.4±0.6 mmol L(-1)); bTOI (NS, 43.9±2.2; HS, 40.1±2.5; AHS, 46.1±2.3%).

CONCLUSIONS

In this model of hypovolemic shock, hypertonic fluids achieved similar end-points as twice the volume of NS. Animals treated with albumin plus hypertonic saline presented prolonged increase in blood volume parameters and recovery of the oxygen debt.

摘要

目的

低血容量性休克复苏不当是导致可预防儿科死亡的主要原因之一。多项研究表明,小剂量高渗或高渗高胶生理盐水可作为有效的初始复苏液。然而,目前尚无儿科研究推荐使用这些液体。本研究旨在确定在失血性休克的婴儿动物模型中,使用高渗液而非等渗晶体液是否会改善整体血流动力学和灌注参数。

方法

这是一项包括 34 只 2 至 3 月龄仔猪的实验性随机动物研究。在控制 30ml/kg 失血 30 分钟后,将仔猪随机分为三组,分别接受生理盐水(NS)30ml/kg(n=11)、3%高渗盐水(HS)15ml/kg(n=12)或 5%白蛋白加 3%高渗盐水(AHS)15ml/kg(n=11)。

结果

容量丢失 30 分钟后,所有组的基础心率(HR)较高,平均动脉压(MAP)较低,心指数(CI)、脑氧合指数(bTOI)和乳酸水平较低,但组间无显著差异。容量补充 30 分钟后,三组间 HR(NS:188±14;HS:184±14;AHS:151±14bpm)、MAP(NS:80±7;HS:86±7;AHS:87±7mmHg)、CI(NS:4.1±0.4;HS:3.9±0.4;AHS:5.1±0.4mLmin-1m-2)、乳酸(NS:2.8±0.7;HS:2.3±0.6;AHS:2.4±0.6mmol/L)和 bTOI(NS:43.9±2.2;HS:40.1±2.5;AHS:46.1±2.3%)无显著差异。

结论

在该低血容量休克模型中,高渗液与 NS 两倍容量的终点相似。用白蛋白和高渗盐水治疗的动物表现出更长时间的血容量参数增加和氧债的恢复。

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