Vassar M J, Fischer R P, O'Brien P E, Bachulis B L, Chambers J A, Hoyt D B, Holcroft J W
Department of Surgery, University of California-Davis, Sacramento.
Arch Surg. 1993 Sep;128(9):1003-11; discussion 1011-3. doi: 10.1001/archsurg.1993.01420210067009.
To evaluate the use of 250 mL of a 7.5% sodium chloride solution, both with and without added dextran 70, for the prehospital resuscitation of hypotensive trauma patients.
Double-blind randomized trial.
Six trauma systems served by helicopter transport.
Injured patients with systolic blood pressures less than 90 mm Hg at any time in the field or during helicopter transport.
Infusion of study solution, in the field or during transport, followed by conventional isotonic solutions as needed. Solutions studied in four cohorts were as follows: (1) lactated Ringer's; (2) 7.5% sodium chloride (hypertonic saline); (3) 7.5% sodium chloride combined with 6% dextran 70; and (4) 7.5% sodium chloride combined with 12% dextran 70.
Blood pressure response; survival to time of hospital discharge among the treatment groups; and survival compared with that predicted by norms from the Major Trauma Outcome Study (MTOS).
The mean (+/- SD) change in systolic blood pressure on arrival in the emergency department was significantly higher in the hypertonic saline solution group than that in the lactated Ringer's solution group (34 +/- 46 vs 11 +/- 49 mm Hg, P < .03). Overall survival in the four treatment groups was 49%, 60%, 56%, and 45% (not statistically significant). Survival in the hypertonic saline solution group, however, was significantly higher than that predicted by the MTOS norms (60% vs 48%, P < .001). Survival to hospital discharge in patients with baseline Glasgow Coma Scale scores of 8 or less was correlated with treatment group (P < .05 by logistic regression and P < .01 by Cox proportional-hazards analysis; with survival in the hypertonic saline solution group [34%] vs lactated Ringer's solution group [12%]).
Prehospital infusion of 250 mL of 7.5% sodium chloride is associated with an increase in blood pressure and an increase in survival to hospital discharge compared with survival predicted by the MTOS norms. Patients with low baseline Glasgow Coma Scale scores seem to benefit the most from 7.5% sodium chloride resuscitation. Hypertonic saline solution without added dextran 70 is as effective as the more expensive solutions that contain dextran 70.
评估250毫升7.5%氯化钠溶液（添加或不添加右旋糖酐70）用于低血压创伤患者院前复苏的效果。
双盲随机试验。
由直升机转运服务的六个创伤救治系统。
在现场或直升机转运过程中任何时间收缩压低于90毫米汞柱的受伤患者。
在现场或转运过程中输注研究溶液，随后根据需要输注常规等渗溶液。四个队列研究的溶液如下：（1）乳酸林格氏液；（2）7.5%氯化钠（高渗盐水）；（3）7.5%氯化钠与6%右旋糖酐70混合；（4）7.5%氯化钠与12%右旋糖酐70混合。
血压反应；各治疗组出院时的生存率；以及与重大创伤结局研究（MTOS）标准预测的生存率相比的实际生存率。
高渗盐溶液组到达急诊科时收缩压的平均（±标准差）变化显著高于乳酸林格氏液组（34±46对11±49毫米汞柱，P<.03）。四个治疗组的总体生存率分别为49%、60%、56%和45%（无统计学意义）。然而，高渗盐溶液组的生存率显著高于MTOS标准预测的生存率（60%对48%，P<.001）。格拉斯哥昏迷量表基线评分8分或更低的患者出院生存率与治疗组相关（逻辑回归P<.05，Cox比例风险分析P<.01；高渗盐溶液组生存率[34%]对乳酸林格氏液组[12%]）。
与MTOS标准预测的生存率相比，院前输注250毫升7.5%氯化钠可使血压升高，出院生存率提高。格拉斯哥昏迷量表基线评分低的患者似乎从7.5%氯化钠复苏中获益最大。未添加右旋糖酐70的高渗盐溶液与含右旋糖酐70的更昂贵溶液效果相同。
