Vassar M J, Perry C A, Holcroft J W
Department of Surgery, School of Medicine, University of California, Davis Medical Center, Sacramento 95817.
J Trauma. 1993 May;34(5):622-32; discussion 632-3.
Small volume infusions of hypertonic saline combined with dextran are very effective in resuscitating animals that have been subjected to hemorrhagic shock, and seem to be effective in resuscitating trauma patients with severe injuries. In this study, the contribution of the dextran component was investigated in a prospective, three-armed, double-blind, randomized trial. Trauma patients transported by ambulance to the hospital with a systolic blood pressure of 90 mm Hg or less were given 250 mL of (1) normal saline (NS); (2) 7.5% NaCl (HS, for hypertonic saline); or (3) 7.5% NaCl in 6% dextran 70 (HSD). Infusion of the study solution was followed by administration of conventional isotonic fluids as the patients' conditions indicated. By predetermined hypothesis, the observed survival rates in the three treatment groups were compared with the predicted survival rates from the TRISS methodology. The 7.5% NaCl solution significantly improved upon the predicted survival for the entire cohort and for high-risk patients when compared with the survival estimates from the TRISS methodology. The addition of a colloid, in the form of 6% dextran 70, did not offer any additional benefit, at least in this setting of rapid urban transport.
小剂量高渗盐水与右旋糖酐联合输注对失血性休克动物的复苏非常有效，对重伤的创伤患者复苏似乎也有效。在本研究中，通过一项前瞻性、三臂、双盲、随机试验研究了右旋糖酐成分的作用。将收缩压90毫米汞柱及以下的创伤患者用救护车送往医院，分别给予250毫升的：(1) 生理盐水(NS)；(2) 7.5%氯化钠(HS，即高渗盐水)；或(3) 6%右旋糖酐70中的7.5%氯化钠(HSD)。根据患者情况，在输注研究溶液后给予常规等渗液体。根据预先设定的假设，将三个治疗组的观察生存率与TRISS方法预测的生存率进行比较。与TRISS方法的生存估计相比，7.5%氯化钠溶液显著提高了整个队列和高危患者的预测生存率。至少在这种快速城市转运的情况下(6%右旋糖酐70形式的)胶体添加没有提供任何额外益处。
