液体限制用于治疗失血性休克未控制状态时可改善预后。

Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic shock.

作者信息

Capone A C, Safar P, Stezoski W, Tisherman S, Peitzman A B

机构信息

Department of Surgery, University of Pittsburgh Medical Center, PA.

出版信息

J Am Coll Surg. 1995 Jan;180(1):49-56.

PMID:8000655

Abstract

BACKGROUND

Recent studies have challenged current guidelines for prehospital fluid resuscitation. However, long-term studies evaluating the consequences of fluid restriction in uncontrolled hemorrhagic shock are lacking. This study was done to examine the long-term effects of deliberate hypotension in the treatment of uncontrolled hemorrhage.

STUDY DESIGN

Uncontrolled hemorrhagic shock was produced in 40 rats by a preliminary bleed (3 mL per 100 g) followed by 75 percent tail amputation. Experimental design consisted of three phases: a "prehospital phase" (90 minutes of uncontrolled bleeding with or without treatment with lactated Ringer's [LR] solution), followed by a "hospital phase" (60 minutes, including control of hemorrhage and fluid resuscitation including blood), and a three day observation phase. Forty rats were studied in four treatment groups (ten rats per group). Group 1 consisted of untreated controls (no resuscitation). Group 2 had no fluid during the prehospital phase. Group 3 had prehospital resuscitation to a mean arterial pressure (MAP) of 40 mm Hg with LR, and group 4 had prehospital resuscitation to MAP of 80 mm Hg with LR. Groups 2, 3, and 4 received fluid and blood to MAP of 80 mm Hg and hematocrit of 30 percent in the hospital phase.

RESULTS

All rats in group 1 (untreated) died within 2.5 hours. Five rats in group 2 (no prehospital FR) survived 90 minutes; however, only one survived three days. In group 3, all ten rats survived 2.5 hours and six survived three days. In group 4, eight rats died within 90 minutes, but none survived long-term. Blood loss (mL per 100 g) for each group was 3.75 0.6 for group 1, 3.35 0.1 for group 2, 4.15 0.8 for group 3, and 8.45 0.6 for group 4, (p < 0.05, group 4 compared with groups 1, 2, and 3).

CONCLUSIONS

Attempts to achieve normal MAP during uncontrolled bleeding increased blood loss, hemodilution and mortality. Hypotensive resuscitation resulted in less acidemia and improved long-term survival.

摘要

背景

近期研究对当前的院前液体复苏指南提出了挑战。然而，缺乏评估在未控制的失血性休克中限制液体摄入后果的长期研究。本研究旨在探讨在治疗未控制的出血时，故意低血压的长期影响。

研究设计

通过初步放血（每100克体重放血3毫升）然后进行75%的尾部截肢，在40只大鼠中制造未控制的失血性休克。实验设计包括三个阶段：“院前阶段”（90分钟未控制的出血，伴或不伴有乳酸林格氏液[LR]治疗），随后是“医院阶段”（60分钟，包括控制出血和液体复苏，包括输血），以及为期三天的观察阶段。在四个治疗组（每组10只大鼠）中对40只大鼠进行了研究。第1组为未治疗的对照组（未进行复苏）。第2组在院前阶段不给予液体。第3组在院前阶段用LR将平均动脉压（MAP）复苏至40毫米汞柱，第4组在院前阶段用LR将MAP复苏至80毫米汞柱。第2、3和4组在医院阶段接受液体和输血，使MAP达到80毫米汞柱，血细胞比容达到30%。

结果

第1组（未治疗）的所有大鼠在2.5小时内死亡。第2组（院前未进行液体复苏）的5只大鼠存活了90分钟；然而，只有1只存活了三天。第3组中，所有10只大鼠存活了2.5小时，6只存活了三天。第4组中，8只大鼠在90分钟内死亡，但无一长期存活。每组的失血量（每100克体重的毫升数）分别为：第1组3.75±0.6，第2组3.35±0.1，第3组4.15±0.8，第4组8.45±0.6，（第4组与第1、2和3组相比，p<0.05）。