Shackford S R, Sise M J, Fridlund P H, Rowley W R, Peters R M, Virgilio R W, Brimm J E
Surgery. 1983 Jul;94(1):41-51.
Fifty-eight patients who were to undergo aortic reconstruction were prospectively randomized into two groups to compare the effects of perioperative fluid replacement with isotonic and hypertonic crystalloid solutions. Blood loss was replaced with packed red blood cells, and additional fluid was given as either Ringer's lactate solution (RL, 130 mEq sodium/L, 274 mOsm/L) or a hypertonic balanced salt solution (HSL, 250 mEq sodium/L, 514 mOsm/L). Fluid was administered to maintain the cardiac filling pressure within 3 torr of the preoperative level and the cardiac output (CO) at or above the preoperative level. The groups were similar with respect to age, preexisting disease, duration of operation, and operative blood loss. During the operation, the RL group required 9.5 +/- 0.8 L of fluid, whereas the HSL group required 4.5 +/- 0.3 L (P less than 0.001). Pulmonary, cardiac, and renal functions were adequately maintained in both groups. There were no significant differences between the groups with regard to CO, urine output, or creatinine clearance during the operation and early postoperative period. Postoperatively, the intrapulmonary shunt was 20 +/- 1% in the RL group and it was 16 +/- 1% in the HSL group (P less than 0.05). The amount of sodium infused and the cumulative sodium balance at the completion of the study period were similar in both groups. Serum sodium and osmolarity were significantly greater in the HSL group (P less than 0.001), reaching a maximum of 151 +/- 1 mEq/L and 305 +/- 2 mOsm/L, respectively. Two patients in the HSL group had a persistent elevation in serum osmolarity (greater than 320 mOsm/L) during operation, for which they received RL for the balance of the resuscitation. There were no complications that could be attributed to the hypertonicity of the solution. HSL is effective for resuscitation of patients with extracellular fluid deficit and is safe provided that the serum sodium and osmolarity are monitored during periods of large volume administration.
58例拟行主动脉重建术的患者被前瞻性随机分为两组，以比较围手术期等渗和高渗晶体溶液补液的效果。失血用浓缩红细胞补充，额外的液体给予乳酸林格液（RL，130 mEq钠/L，274 mOsm/L）或高渗平衡盐溶液（HSL，250 mEq钠/L，514 mOsm/L）。补液以维持心脏充盈压在术前水平3 torr以内，心输出量（CO）在术前水平或以上。两组在年龄、基础疾病、手术时间和术中失血量方面相似。手术期间，RL组需要9.5±0.8 L液体，而HSL组需要4.5±0.3 L（P<0.001）。两组的肺、心脏和肾功能均得到充分维持。两组在手术期间和术后早期的CO、尿量或肌酐清除率方面无显著差异。术后，RL组肺内分流为20±1%，HSL组为16±1%（P<0.05）。两组在研究期结束时输注的钠量和累积钠平衡相似。HSL组的血清钠和渗透压显著更高（P<0.001），分别最高达到151±1 mEq/L和305±2 mOsm/L。HSL组有2例患者在手术期间血清渗透压持续升高（>320 mOsm/L），为此他们在复苏的剩余时间接受了RL。没有可归因于溶液高渗性的并发症。HSL对细胞外液不足的患者复苏有效，并且在大量给药期间监测血清钠和渗透压的情况下是安全的。
