Sheikh A A, Eaker J A, Chin C C, Gunther R A, Kramer G C
Department of Pediatrics, University of California at Davis, USA.
Crit Care Med. 1996 Jun;24(6):1054-61. doi: 10.1097/00003246-199606000-00028.
To study the efficacy of a low sodium hypertonic resuscitation fluid for resuscitation of severe hemorrhage in a pediatric animal, using the intraosseous route.
Prospective, randomized, controlled animal study.
University physiology laboratory.
Seventeen immature (6- to 9-wk-old) piglets, weighing 10.6 +/- 0.4 kg, were studied under anesthesia.
A new 2400 mosm/L hypertonic fluid, "Isosal" was formulated with reduced (3.45%) sodium content compared with a 2400-mosm/L (7.5%) hypertonic saline solution. This formulation was accomplished by substituting glucose and mixed amino acids for sodium. Piglets were subjected to 1 hr of hemorrhage, reducing the cardiac output to 50% of baseline value. Resuscitation was carried out through the intraosseous route with an initial 6 mL/kg bolus of either hypertonic saline, Isosal, or lactated Ringer's solution. After the initial bolus, additional test fluid was given to maintain the cardiac output at baseline value for a 2-hr period.
Total resuscitation volumes, hemodynamic variables, and electrolytes were measured. Intraosseous vascular access was easily established in all animals, and fluid resuscitation was carried out effectively through this route. Resuscitation volumes were significantly lower for both of the hypertonic fluids (12.7 +/- 1.2 mL/kg for hypertonic saline, and 12.5 +/- 1.7 mL/kg for Isosal solution) compared with lactated Ringer's solution (75.3 +/- 11.6 mL/kg) (p = .01). Both hypertonic saline and Isosal solution resulted in an immediate supranormal response in cardiac output that lasted 20 mins. In contrast, when lactated Ringer's solution was used, multiple boluses were required over a 20-min period to normalize cardiac output. Serum sodium was significantly higher in the hypertonic saline group compared with the Isosal or lactated Ringer's groups (p = .001).
Isosal solution was as effective as hypertonic saline in "small volume" resuscitation of severe hemorrhagic shock in a pediatric animal model through the intraosseous route, and produced significantly less hypernatremia when compared with hypertonic saline.
研究一种低钠高渗复苏液经骨内途径用于小儿动物严重出血复苏的疗效。
前瞻性、随机、对照动物研究。
大学生理学实验室。
17只未成熟（6至9周龄）仔猪，体重10.6±0.4千克，在麻醉状态下进行研究。
一种新的2400毫渗量/升高渗液“Isosal”，与2400毫渗量/升（7.5%）高渗盐溶液相比，其钠含量降低（3.45%）。通过用葡萄糖和混合氨基酸替代钠来实现这种配方。仔猪经历1小时出血，使心输出量降至基线值的50%。通过骨内途径进行复苏，初始推注高渗盐水、Isosal或乳酸林格氏液，剂量为6毫升/千克。初始推注后，给予额外的试验液以在2小时内将心输出量维持在基线值。
测量总复苏液量、血流动力学变量和电解质。所有动物均易于建立骨内血管通路，且通过该途径有效地进行了液体复苏。与乳酸林格氏液（75.3±11.6毫升/千克）相比，两种高渗液的复苏液量均显著更低（高渗盐水为12.7±1.2毫升/千克，Isosal溶液为12.5±1.7毫升/千克）（p = 0.01）。高渗盐水和Isosal溶液均导致心输出量立即出现超正常反应，持续20分钟。相比之下，使用乳酸林格氏液时，在20分钟内需要多次推注才能使心输出量恢复正常。高渗盐水组的血清钠显著高于Isosal组或乳酸林格氏液组（p = 0.001）。
在小儿动物模型中，通过骨内途径，Isosal溶液在严重失血性休克的“小容量”复苏中与高渗盐水效果相同，且与高渗盐水相比，产生的高钠血症明显更少。
