Maningas P A
Division of Military Trauma Research, Letterman Army Institute of Research, Presidio of San Francisco, CA 94129-6800.
Crit Care Med. 1987 Dec;15(12):1121-6. doi: 10.1097/00003246-198712000-00009.
We previously reported that small volume infusions of 7.5% NaCl in 6% dextran-70 (HSD) are superior to equal volumes of normal saline (NS) or 7.5% NaCl in the ability to resuscitate animals from an otherwise lethal hemorrhage. In the present experiment, we evaluated organ blood flow in unanesthetized swine bled 46 ml/kg in 15 min and subsequently infused with a volume of HSD (n = 5) or NS (n = 5) equal to 25% of the shed blood. Radiomicrospheres were injected before hemorrhage, immediately after hemorrhage, and 5 and 30 min after treatment. At the end of hemorrhage, cardiac output had fallen to one-third of baseline values. Five minutes after the infusion of HSD, cardiac output had returned to baseline levels, while cardiac output in the NS-treated controls had increased to only one-half of prehemorrhage values. Blood flows to the brain, diaphragm, skin, muscle, and fat were not different between the two groups. Infusion with HSD, however, produced flows to the myocardium, kidneys, liver, small intestine, and pancreas that were significantly greater than post-hemorrhage and NS-treated control values. NS was unable to increase these flows significantly above post-hemorrhage levels. We conclude that small volumes of HSD can significantly improve organ blood flow after hemorrhagic shock. This improvement in flow may explain the increased survival observed with this solution and may attenuate some of the later complications of hemorrhagic shock.
我们之前报道过，在将动物从致死性出血中复苏的能力方面，小剂量输注7.5%氯化钠与6%右旋糖酐-70（高渗盐右旋糖酐溶液，HSD）优于等体积的生理盐水（NS）或7.5%氯化钠。在本实验中，我们评估了在15分钟内失血46 ml/kg的未麻醉猪的器官血流情况，随后分别给5只猪输注与失血量25%等量的HSD，给另外5只猪输注等量的NS。在出血前、出血后即刻、治疗后5分钟和30分钟注射放射性微球。出血结束时，心输出量降至基线值的三分之一。输注HSD后5分钟，心输出量恢复到基线水平，而接受NS治疗的对照组心输出量仅增加到出血前值的一半。两组之间脑、膈肌、皮肤、肌肉和脂肪的血流没有差异。然而，输注HSD后，心肌、肾脏、肝脏、小肠和胰腺的血流显著高于出血后及接受NS治疗的对照组的值。NS未能使这些血流显著高于出血后的水平。我们得出结论，小剂量的HSD可显著改善失血性休克后的器官血流。血流的这种改善可能解释了使用该溶液观察到的生存率增加的现象，并且可能减轻失血性休克的一些后期并发症。
