Modig J
Department of Anesthesiology and Intensive Care, University Hospital of Uppsala, Sweden.
Resuscitation. 1988 Jan;16(1):1-12. doi: 10.1016/0300-9572(88)90014-7.
The effects of Dextran 70 with NaCl as against Ringer's acetate on hemodynamics, gas exchange, oxygen transport and survival were evaluated in a porcine model of pulmonary and circulatory insufficiency induced by a continuous i.v. endotoxin infusion over 6 h. Dextran and Ringer's acetate were infused continuously to maintain baseline mean left atrial pressure (MLAP) throughout the endotoxin period. Twelve pigs receiving endotoxin + Ringer's acetate displayed a progressive 45% decline in cardiac output (Qt) and a two peaked increase in pulmonary vascular resistance (PVR) with a late increase of 250%. Venous admixture (Qva/Qt) increased progressively more than 6-fold and extravascular lung water (EVLW) increased by 55%. Mean arterial blood pressure (MAP) fell by 25%, oxygen delivery by 40%, base excess (BE) ranged between - 4.5 and - 9 mmol.1(-1) at the end of the endotoxin period and 4 of 12 animals died. Polymorphonuclear cell count (PMNs) fell rapidly by 90% and was severely decreased throughout the endotoxin period. Contrastingly, the 12 pigs that received endotoxin + Dextran maintained Qt near baseline and PVR was significantly lower in this group. Qva/Qt increased progressively more than 4-fold, but was significantly lower than in the Ringer's group as was the increase in EVLW (23%). MAP only decreased by 10%, oxygen delivery only decreased by 20%. BE ranged between - 1.0 and - 3.0 at the end of the endotoxin period and all animals survived. PMNs fell by 90% at 0.5 h but subsequently tended to return towards baseline. PMNs were significantly increased compared with the Ringer's group. The amount of Ringer's acetate necessary to maintain a stable MLAP averaged 4.6 times the Dextran volume. The superiority of Dextran as compared with Ringer's acetate in this endotoxemic shock model seems to be consequent to better rheological effects combined with pharmacological interactions with granulocytes.
在通过连续静脉输注内毒素6小时诱导的猪肺循环功能不全模型中，评估了右旋糖酐70与氯化钠联用对比醋酸林格液对血流动力学、气体交换、氧输送和存活率的影响。在内毒素输注期间，持续输注右旋糖酐和醋酸林格液以维持基线平均左心房压（MLAP）。接受内毒素+醋酸林格液的12头猪心输出量（Qt）逐渐下降45%，肺血管阻力（PVR）出现双峰增加，后期增加250%。静脉血掺杂（Qva/Qt）逐渐增加超过6倍，血管外肺水（EVLW）增加55%。平均动脉血压（MAP）下降25%，氧输送下降40%，内毒素输注期末碱剩余（BE）在-4.5至-9 mmol·L⁻¹之间，12只动物中有4只死亡。多形核细胞计数（PMNs）迅速下降90%，在内毒素输注期间一直严重减少。相比之下，接受内毒素+右旋糖酐的12头猪Qt维持在基线附近，该组PVR显著更低。Qva/Qt逐渐增加超过4倍，但显著低于林格液组，EVLW增加幅度（23%）也是如此。MAP仅下降10%，氧输送仅下降20%。内毒素输注期末BE在-1.0至-3.0之间，所有动物存活。PMNs在0.5小时时下降90%，但随后趋于恢复至基线。与林格液组相比，PMNs显著增加。维持稳定MLAP所需的醋酸林格液量平均为右旋糖酐体积的4.6倍。在该内毒素性休克模型中，右旋糖酐相比醋酸林格液的优势似乎源于更好的流变学效应以及与粒细胞的药理相互作用。
