Diebel L N, Robinson S L, Wilson R F, Dulchavsky S A
Department of Surgery, Wayne State University, Detroit, Michigan 48201.
Am Surg. 1993 Aug;59(8):495-9.
A porcine hemorrhagic shock (HS) model was used to assess the splanchnic mucosal and systemic effects of hypertonic versus isotonic crystalloid resuscitation. Animals were bled to a mean arterial pressure of 40 mm Hg for 1 hour and then resuscitated with equivalent sodium loads of LR, 7.5 per cent hypertonic saline (HSS), or 7.5 per cent HSS with 6 per cent Dextran (HSD). Intestinal mucosal blood flow (IMBF) was measured by a laser Doppler flow probe placed on the mucosa of the small bowel. Following resuscitation the cardiac output (CO) (relative to baseline values) was significantly higher with HSD (158 17 per cent) and HSS (137 24 per cent) than with LR (84 27 per cent) (P < 0.005). There was prompt restoration of IMBF with both HSD (126 31 per cent) and HSS (106 22 per cent) (vs baseline). Resuscitation with LR was associated with a persistent reduction in IMBF (52 16 per cent) despite restoration of mean arterial pressure and cardiac output to baseline levels (P < 0.05). Thus, hypertonic saline solutions may serve an adjunctive role in the resuscitation of hemorrhagic shock by restoring intestinal nutrient blood flow and, thereby, preventing gut barrier impairment, bacterial translocation, and organ failure.
采用猪失血性休克（HS）模型评估高渗与等渗晶体液复苏对内脏黏膜及全身的影响。将动物放血至平均动脉压为40 mmHg，持续1小时，然后分别用乳酸林格液（LR）、7.5%高渗盐水（HSS）或含6%右旋糖酐的7.5%高渗盐水（HSD）进行等钠负荷复苏。通过置于小肠黏膜的激光多普勒血流探头测量肠黏膜血流量（IMBF）。复苏后，HSD组（158±17%）和HSS组（137±24%）的心输出量（相对于基线值）显著高于LR组（84±27%）（P<0.005）。HSD组（126±31%）和HSS组（106±22%）的IMBF均迅速恢复至基线水平（与基线相比）。尽管平均动脉压和心输出量恢复到基线水平，但LR复苏组的IMBF仍持续降低（52±16%）（P<0.05）。因此，高渗盐溶液可能通过恢复肠道营养血流，从而预防肠屏障功能损害、细菌易位和器官衰竭，在失血性休克复苏中起到辅助作用。
