Feldman Z, Zachari S, Reichenthal E, Artru A A, Shapira Y
Department of Neurosurgery, Soroka Medical Center, Beer-Sheva, Israel.
J Neurosurg. 1995 Dec;83(6):1060-6. doi: 10.3171/jns.1995.83.6.1060.
Rapid infusion of 0.25 ml/g of 0.9% saline over 30 minutes has been shown to have no effect on electrolyte balance, neurological severity score (NSS), or brain edema, following closed head trauma (CHT). Rapid infusion of the same volume of 5% dextrose solution decreased blood sodium concentration, increased edema, and decreased NSS following CHT. In the present study the authors examined the effect of rapid infusion (30 minutes) of smaller volumes of 5% dextrose (0.08 ml/g and 0.16 ml/g) and of 0.25 ml/g lactated Ringer's solution on blood electrolyte concentrations, plasma osmolality, brain edema, and NSS. The purposes of this study were to determine whether rapid infusion of a large volume of lactated Ringer's solution could be given after CHT without increasing mortality or brain edema or producing electrolyte disturbances, and whether small volumes of 5% dextrose could be infused with few or none of the deleterious effects expected from large volumes of 5% dextrose. One hundred eighteen rats, which survived halothane anesthesia and CHT, were randomly assigned to one of 15 experimental groups. Fluids were administered beginning 1 hour after scalp incision or CHT. The NSS, extent of edema, blood electrolyte concentrations, and plasma osmolality in the groups treated with lactated Ringer's solution were not significantly different from those values in the nontreated groups. In addition, the mortality rate after CHT was not increased by administration of lactated Ringer's solution. The groups treated with 5% dextrose solution showed a significantly higher mortality rate, but the NSSs of the surviving rats were not different from controls. None of the groups treated with 0.16 ml/g 5% dextrose solution survived 24 hours. Although blood glucose concentration increased to 1126 +/- 102 g% (mean +/- standard deviation) and 1568 +/- 283 g% and blood sodium concentration decreased to 110.4 +/- 4.6 mEq/L and 92.0 +/- 5.2 mEq/L in the groups treated with 0.08 ml/g and 0.16 ml/g of 5% dextrose solution, respectively, plasma osmolality was normal and no significant difference could be found between the brain tissue specific gravity of animals in the nontreated and 5% dextrose treatment groups. It is concluded that in the CHT model used in this study, the large volume of lactated Ringer's solution did not affect blood electrolyte concentration, neurological outcome, or formation of brain edema, whereas smaller volumes of 5% dextrose solution increased blood glucose and decreased blood sodium concentrations, did not affect plasma osmolality, and had a deleterious effect on neurological outcome.
研究表明，在闭合性颅脑损伤（CHT）后，30分钟内快速输注0.25ml/g的0.9%生理盐水对电解质平衡、神经严重程度评分（NSS）或脑水肿均无影响。快速输注相同体积的5%葡萄糖溶液会降低血钠浓度，增加水肿，并降低CHT后的NSS。在本研究中，作者检测了快速输注（30分钟）较小体积的5%葡萄糖（0.08ml/g和0.16ml/g）以及0.25ml/g乳酸林格氏液对血电解质浓度、血浆渗透压、脑水肿和NSS的影响。本研究的目的是确定CHT后快速输注大量乳酸林格氏液是否会增加死亡率或脑水肿或引起电解质紊乱，以及小体积的5%葡萄糖溶液输注后是否几乎不会产生或完全不会产生大量5%葡萄糖溶液预期的有害影响。118只在氟烷麻醉和CHT后存活的大鼠被随机分配到15个实验组之一。在头皮切开或CHT后1小时开始给予液体。接受乳酸林格氏液治疗的组的NSS、水肿程度、血电解质浓度和血浆渗透压与未治疗组的值无显著差异。此外，给予乳酸林格氏液并未增加CHT后的死亡率。接受5%葡萄糖溶液治疗的组显示出显著更高的死亡率，但存活大鼠的NSS与对照组无差异。接受0.16ml/g 5%葡萄糖溶液治疗的组中没有一只大鼠存活24小时。尽管在分别接受0.08ml/g和0.16ml/g 5%葡萄糖溶液治疗的组中，血糖浓度分别升高至1126±102mg%（平均值±标准差）和1568±283mg%，血钠浓度分别降至110.4±4.6mEq/L和92.0±5.2mEq/L，但血浆渗透压正常，未治疗组和5%葡萄糖治疗组动物的脑组织比重之间未发现显著差异。得出的结论是，在本研究使用的CHT模型中，大量乳酸林格氏液不影响血电解质浓度、神经学转归或脑水肿形成，而较小体积的5%葡萄糖溶液会升高血糖和降低血钠浓度，不影响血浆渗透压，并对神经学转归有有害影响。
