Poli de Figueiredo L F, Peres C A, Attalah A N, Romaldini H, Miranda F, Francisco J, Burihan E
Vascular Surgery,Department of Surgery, Escola Paulista de Medicina, Sao Paulo, Brazil.
Cardiovasc Surg. 1995 Dec;3(6):679-86. doi: 10.1016/0967-2109(96)82869-9.
The initial treatment of uncontrolled hemorrhage shock from an abdominal source is controversial. The hemodynamic effects of transfemoral diaphragmatic aortic occlusion with a balloon followed by a single bolus of hypertonic saline solutions have been evaluated in 28 dogs. The animals were submitted to pressure-driven hemorrhage for 90 min, according to mean arterial pressure in the abdominal aorta and randomized into four groups, according to the treatment employed at 34 min after hemorrhage. Group 1 dogs (controls) received isotonic NaCl (0.9%, 208 mOsm/l, 4 ml/kg) without aortic occlusion; group 2 underwent aortic occlusion and received isotonic NaCl (0.9%, 308 mOsm/l, 4 ml/kg): group 3 were occluded and received hypertonic NaCl (7.5%, 2400 mOsm/l, 4 ml/kg); group 4 were occluded and received hypertonic sodium acetate (10.5%, 2400 mOsm/l, 4 ml/kg). There were no significant differences between groups at basal measures and also after 30 min of continuous bleeding, when animals presented with severe shock, and significant decreases in mean arterial pressure, cardiac index, systolic index and cardiac filling pressures; the systemic vascular resistance index was increased. Control animals remained in severe shock throughout the experiment and three died. The recovery of mean arterial pressure in aortic-occluded dogs given isotonic NaCl was associated with a marked increase in systemic vascular resistance index, without improvements in cardiac index, systolic index and cardiac filling pressures. In occluded dogs given hypertonic NaCl and NaAc the mean arterial pressure recovery lasted longer, with lower increases in systemic vascular resistance index, while the cardiac index, systolic index and cardiac filling pressures showed a marked albeit transient increase. Injection of hypertonic saline following aortic occlusion produced significantly better hemodynamic profiles and should be seriously considered for the first treatment in severe uncontrolled hemorrhagic shock from an abdominal vascular source.
腹部来源的失血性休克控制不佳时的初始治疗存在争议。已对28只犬评估了经股动脉用球囊阻断膈下主动脉，随后单次推注高渗盐溶液的血流动力学效应。根据腹主动脉平均动脉压，使动物承受压力驱动的出血90分钟，并根据出血后34分钟采用的治疗方法随机分为四组。第1组犬（对照组）未进行主动脉阻断，接受等渗氯化钠（0.9%，208 mOsm/l，4 ml/kg）；第2组进行主动脉阻断，接受等渗氯化钠（0.9%，308 mOsm/l，4 ml/kg）；第3组进行主动脉阻断，接受高渗氯化钠（7.5%，2400 mOsm/l，4 ml/kg）；第4组进行主动脉阻断，接受高渗醋酸钠（10.5%，2400 mOsm/l，4 ml/kg）。在基础测量时以及持续出血30分钟后，即动物出现严重休克、平均动脉压、心脏指数、收缩指数和心脏充盈压显著降低且全身血管阻力指数升高时，各组之间无显著差异。对照动物在整个实验过程中一直处于严重休克状态，3只死亡。接受等渗氯化钠的主动脉阻断犬平均动脉压的恢复与全身血管阻力指数的显著增加相关，而心脏指数、收缩指数和心脏充盈压并无改善。接受高渗氯化钠和醋酸钠的阻断犬平均动脉压的恢复持续时间更长，全身血管阻力指数升高幅度较小，而心脏指数、收缩指数和心脏充盈压则出现显著但短暂的升高。主动脉阻断后注射高渗盐溶液产生了明显更好的血流动力学特征，对于腹部血管来源的严重失血性休克的初始治疗应予以认真考虑。
