Goertz A W, Mehl T, Lindner K H, Rockemann M G, Schirmer U, Schwilk B, Georgieff M
Department of Anesthesiology, University of Ulm, Germany.
Anesthesiology. 1995 Jun;82(6):1389-95. doi: 10.1097/00000542-199506000-00010.
Although a positive inotropic effect of hypertonic saline has been demonstrated in isolated cardiac tissue as well as in animal preparations, no information exists about a possible positive inotropic action of hypertonic saline in humans. The aim of this investigation was to determine whether a clinically relevant positive inotropic effect can be demonstrated in humans.
Twenty-six patients without cardiovascular disease were randomized to receive 4 ml/kg of either 7.2% hypertonic saline/6% hetastarch or 6% hetastarch (control) at a rate of 1 ml.kg-1.min-1 while under general endotracheal anesthesia. Transesophageal echocardiography was used to evaluate left ventricular function. Arterial pressure, heart rate, and left ventricular end-systolic and end-diastolic diameter, area, and wall thickness were measured immediately before and after administration of either solution. Fractional area change, end-systolic wall stress, and the area under the end-systolic pressure-length relationship curve (ESPLRarea) were calculated. ESPLRarea was used to assess left ventricular contractility.
Administration of hypertonic saline/hetastarch resulted in a significant decrease of mean arterial pressure and end-systolic wall stress from 77 +/- 14 (mean +/- SD) to 64 +/- 17 mmHg (P < 0.01) and from 52 +/- 14 to 32 +/- 11 10(3) dyne/cm2 (P > 0.01), respectively. End-diastolic area and fractional area change increased from 16.5 +/- 2.9 to 21.7 +/- 3.3 cm2 (P < 0.01) and from 0.53 +/- 0.07 to 0.70 +/- 0.06 (P < 0.01), respectively, whereas there was only a minor change of ESPLRarea from 38 +/- 13 to 44 +/- 13 mmHg.cm (P < 0.05).
The apparent improvement of left ventricular systolic function in response to hypertonic saline/hetastarch is caused mainly by the combined effect of increased left ventricular preload and reduced left ventricular afterload. A possible positive inotropic action of hypertonic saline/hetastarch is not likely to be clinically relevant.
尽管高渗盐水在离体心脏组织以及动物实验中已被证明具有正性肌力作用，但尚无关于高渗盐水在人体中可能存在的正性肌力作用的相关信息。本研究的目的是确定在人体中是否能证明其具有临床相关的正性肌力作用。
26例无心血管疾病的患者在全身气管内麻醉下，随机接受以1ml·kg⁻¹·min⁻¹的速度输注4ml/kg的7.2%高渗盐水/6%羟乙基淀粉或6%羟乙基淀粉（对照组）。采用经食管超声心动图评估左心室功能。在输注两种溶液之前和之后立即测量动脉压、心率以及左心室收缩末期和舒张末期直径、面积和壁厚度。计算面积变化分数、收缩末期壁应力以及收缩末期压力-长度关系曲线下面积（ESPLRarea）。ESPLRarea用于评估左心室收缩性。
输注高渗盐水/羟乙基淀粉导致平均动脉压和收缩末期壁应力显著降低，分别从77±14（平均值±标准差）降至64±17mmHg（P<0.01），从52±14降至32±11×10³达因/cm²（P>0.01）。舒张末期面积和面积变化分数分别从16.5±2.9增加至21.7±3.3cm²（P<0.01）和从0.53±0.07增加至0.70±0.06（P<0.01），而ESPLRarea仅从38±13轻微变化至44±13mmHg·cm（P<0.05）。
高渗盐水/羟乙基淀粉引起的左心室收缩功能的明显改善主要是由左心室前负荷增加和左心室后负荷降低的联合作用所致。高渗盐水/羟乙基淀粉可能的正性肌力作用在临床上不太可能具有相关性。
