Soucy D M, Sindlinger J F, Greene S P, Barber A E, Illner H P, Shires G T
Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA.
Ann Surg. 1995 Jul;222(1):87-93. doi: 10.1097/00000658-199507000-00014.
The authors evaluated the effect of early fluid resuscitation with isotonic saline (NaCl, 0.9%) on uncontrolled hemorrhage in rats under different anesthetic conditions. SUMMARY/BACKGROUND DATA: Recently, it has been suggested that administration of fluids to patients during uncontrolled hemorrhage may produce adverse effects, and a postponement of resuscitation until surgical control of bleeding was recommended. Past clinical trials were inconclusive, and the results of recent experimental studies were affected by use of vasoactive anesthetics.
One hundred thirty-five female Sprague-Dawley rats were randomly divided into three groups: group 1--unanesthetized; group 2--anesthetized with sodium pentobarbital; and group 3--anesthetized with a mixture of droperidol and ketamine. Uncontrolled hemorrhage was initiated with a 75% tail resection, and each group was further subdivided into three subgroups for the following treatment: (A) no resuscitation; (B) 40 mL/kg of isotonic saline; or (C) 80 mL/kg of isotonic saline, administered 15 minutes after the initiation of hemorrhage. Blood loss volume and survival time were recorded, and animals were observed up to 360 minutes.
At 6 hours, nonresuscitated animals of all groups exhibited the highest mortality rates (93%, 73%, 100% in groups 1, 2, and 3, respectively). Resuscitation significantly improved the survival; lowest mortality rates were observed after resuscitation with 80 mL/kg in groups 1 and 3 (33%) and 40 mL/kg in group 2 (40%). Fluid infusion increased hemorrhage rates in all anesthetized rats. No such increases in bleeding were observed in group 1.
Resuscitation with isotonic saline improved mortality in uncontrolled hemorrhage, even with concomitant increases in hemorrhage rates, under all three anesthetic conditions tested. Unanesthetized rats bled less than the animals under anesthesia and did not exhibit an increased blood loss in response to fluid infusion.
作者评估了在不同麻醉条件下，用等渗盐水（0.9%氯化钠）进行早期液体复苏对大鼠非控制性出血的影响。总结/背景资料：最近，有人提出在非控制性出血期间给患者补液可能会产生不良影响，并建议在手术控制出血之前推迟复苏。过去的临床试验尚无定论，最近的实验研究结果受到血管活性麻醉剂使用的影响。
135只雌性Sprague-Dawley大鼠被随机分为三组：第1组——未麻醉；第2组——用戊巴比妥钠麻醉；第3组——用氟哌利多和氯胺酮混合物麻醉。通过切除75%的尾巴引发非控制性出血，每组再进一步细分为三个亚组进行以下处理：（A）不复苏；（B）40 mL/kg等渗盐水；或（C）80 mL/kg等渗盐水，在出血开始15分钟后给予。记录失血量和存活时间，并对动物观察长达360分钟。
6小时时，所有组未复苏的动物死亡率最高（第1、2和3组分别为93%、73%、100%）。复苏显著提高了存活率；第1组和第3组用80 mL/kg复苏后死亡率最低（33%），第2组用40 mL/kg复苏后死亡率最低（40%）。液体输注增加了所有麻醉大鼠的出血率。第1组未观察到此类出血增加。
在所有三种测试的麻醉条件下，用等渗盐水复苏可提高非控制性出血的死亡率，即使同时出血率增加。未麻醉的大鼠比麻醉的动物出血少，并且对液体输注未表现出失血量增加。
