Matsuoka T, Hildreth J, Wisner D H
Department of Surgery, University of California-Davis, School of Medicine, Sacramento 95817, USA.
J Trauma. 1995 Oct;39(4):674-80. doi: 10.1097/00005373-199510000-00010.
Using a standardized liver injury model of uncontrolled hemorrhage, we tested the effect of different hypertonic solutions on mortality, blood pressure, intra-abdominal bleeding, and circulating blood volume. After liver injury, rats were randomized to 4 groups: lactated Ringer's (LR, n = 10), Isosal (ISO, n = 10), hypertonic saline (HS, n = 10), and hypertonic sodium acetate (HA, n = 10). In all resuscitation groups, 4 mL/kg was infused at a rate of 0.4 mL/min. Blood volume was evaluated both directly and by estimation. Mortality was highest after HA resuscitation (40%) and lowest after HS resuscitation (0%), but this difference was not significant. Blood pressure was significantly higher after HS resuscitation, and this difference was sustained for 4 hours. The HA resuscitation did not increase blood pressure compared with LR resuscitation. Intraperitoneal blood volume was significantly higher with HS (25.5 +/- 0.7 mL/kg) and HA (26.8 +/- 1.2 mL/kg) than with LR (22.5 +/- 0.4 mL/kg). The HA resuscitation led to a significantly larger drop from baseline values of estimated terminal circulating blood volume than LR resuscitation. Nonparametric analysis combining survival time and directly measured change in blood volume demonstrated a significant advantage to HS, compared with LR. HA and HS resuscitations increased bleeding from uncontrolled solid viscus injury. The HS resuscitation restored blood pressure better than the other hypertonic solutions and maintained circulating blood volume in spite of increased bleeding. The HA and ISO resuscitations did not exhibit any advantage over LR in resuscitation of solid viscus injury.
我们使用了一种非控制性出血的标准化肝损伤模型，测试了不同高渗溶液对死亡率、血压、腹腔内出血和循环血容量的影响。肝损伤后，将大鼠随机分为4组：乳酸林格液（LR，n = 10）、等渗液（ISO，n = 10）、高渗盐水（HS，n = 10）和高渗醋酸钠（HA，n = 10）。在所有复苏组中，以0.4 mL/min的速率输注4 mL/kg。通过直接测量和估算来评估血容量。HA复苏后的死亡率最高（40%），HS复苏后的死亡率最低（0%），但这种差异不显著。HS复苏后的血压显著更高，且这种差异持续了4小时。与LR复苏相比，HA复苏并未使血压升高。HS（25.5±0.7 mL/kg）和HA（26.8±1.2 mL/kg）组的腹腔内血容量显著高于LR组（22.5±0.4 mL/kg）。与LR复苏相比，HA复苏导致估计的终末循环血容量较基线值有显著更大的下降。结合生存时间和直接测量的血容量变化的非参数分析表明，与LR相比，HS具有显著优势。HA和HS复苏增加了非控制性实体脏器损伤的出血。尽管出血增加，但HS复苏比其他高渗溶液能更好地恢复血压并维持循环血容量。在实体脏器损伤的复苏方面，HA和ISO复苏相对于LR没有表现出任何优势。
