Rocha e Silva M, Braga G A, Prist R, Velasco I T, Grança E S
Research Division, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, Brasil.
J Trauma. 1993 Aug;35(2):200-5. doi: 10.1097/00005373-199308000-00005.
Two different hypertonic (2400 mOsm/L) isochloremic dextran solutions (sodium acetate, HAD; and sodium lactate, HLD; in 0.9% NaCl + 6% dextran 70) were compared with HSD (2400 mOsm/L NaCl + 6% dextran 70) as initial treatment for severe uninterrupted arterial bleeding. The substitution of dextran 70 for lactated Ringer's solution as the maintenance isotonic infusion fluid was also analyzed. Experiments were performed in pentobarbital-anesthetized dogs. A recently developed model, pressure-driven hemorrhage (PDH), which mimics uninterrupted arterial bleeding, was employed. It was found that (1) the substitution of dextran 70 for lactated Ringer's as isotonic fluid makes no difference in hemodynamic terms; (2) isochloremic hypertonic solutions are similar in their hemodynamic resuscitative effect, representing an improvement over hypertonic NaCl in terms of cardiac output, O2 delivery and O2 consumption; (3) HAD proved superior to HLD in terms of O2 consumption and correction of pH/base excess.
将两种不同的高渗（2400 mOsm/L）等氯右旋糖酐溶液（醋酸钠，HAD；和乳酸钠，HLD；于0.9%氯化钠+6%右旋糖酐70中）与高渗氯化钠右旋糖酐溶液（HSD，2400 mOsm/L氯化钠+6%右旋糖酐70）作为严重持续性动脉出血的初始治疗进行比较。还分析了用右旋糖酐70替代乳酸林格氏液作为维持性等渗输液的情况。实验在戊巴比妥麻醉的犬身上进行。采用了一种最近开发的模型，压力驱动出血（PDH），其模拟持续性动脉出血。结果发现：（1）用右旋糖酐70替代乳酸林格氏液作为等渗液在血流动力学方面无差异；（2）等氯高渗溶液在血流动力学复苏效果方面相似，在心输出量、氧输送和氧消耗方面比高渗氯化钠有所改善；（3）在氧消耗和pH/碱剩余的纠正方面，HAD被证明优于HLD。
