Ho H S, Sondeen J L, Dubick M A, Wade C E, Gunther R A
Department of Surgery, University of California at Davis, School of Medicine 95616, USA.
Shock. 1996 Apr;5(4):289-97. doi: 10.1097/00024382-199604000-00010.
A small volume of 7.5% NaCl/6% Dextran-70 (HSD) can rapidly expand the plasma volume, but concerns exist regarding its adverse effects on renal function in the dehydrated state. Sheep were thirsted for 4 days (13% plasma volume contraction), and subjected to a fixed-pressure shock model (mean arterial pressure of 50 mmHg for 2 h), followed by resuscitation with either HSD (4 mL/kg) or lactated Ringer's solution (LR; 37 mL/kg). Mean arterial pressure was restored to 90%, cardiac output to 125% and 120%, and plasma volume to 78% and 72% of baseline in LR and HSD groups, respectively. Glomerular filtration rate improved to 100% of baseline following HSD compared with 82% following LR. No significant urinary 70,000 molecular weight dextran was observed, suggesting an intact renal glomerular membrane. These data suggest that small volume HSD resuscitation is effective, even with pre-existing dehydration. In addition, renal function is not compromised by HSD resuscitation of hemorrhaged, dehydrated animals.
小剂量的7.5%氯化钠/6%右旋糖酐-70（高渗盐右旋糖酐溶液，HSD）能迅速扩充血浆容量，但对于其在脱水状态下对肾功能的不良影响仍存在担忧。将绵羊禁水4天（血浆容量收缩13%），使其经受固定压力休克模型（平均动脉压50 mmHg，持续2小时），随后分别用HSD（4 mL/kg）或乳酸林格氏液（LR；37 mL/kg）进行复苏。LR组和HSD组的平均动脉压分别恢复至基线的90%、心输出量分别恢复至基线的125%和120%、血浆容量分别恢复至基线的78%和72%。与LR组复苏后肾小球滤过率提高至基线的82%相比，HSD组复苏后肾小球滤过率提高至基线的100%。未观察到明显的尿70000分子量右旋糖酐，提示肾小球膜完整。这些数据表明，即使存在预先存在的脱水情况，小剂量HSD复苏也是有效的。此外，HSD对出血性脱水动物的复苏不会损害肾功能。
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