Silbergleit R, Satz W, McNamara R M, Lee D C, Schoffstall J M
Medical College of Pennsylvania, Department of Emergency Medicine Philadelphia 19129, USA.
Acad Emerg Med. 1996 Oct;3(10):922-6. doi: 10.1111/j.1553-2712.1996.tb03320.x.
To determine the effects of aggressive fluid administration vs permissive hypotension on survival, blood loss, and hemodynamics in a model of uncontrolled hemorrhage in which bleeding has been shown to be continuous.
In this porcine model, 10 animals were bled through a flow-monitored shunt placed between the femoral artery and the peritoneal cavity. The animals received either no fluid (n = 5) or 80 mL/kg lactated Ringer's solution (n = 5) during a resuscitation phase between 10 and 20 minutes postinjury, followed by a 40-minute evaluation phase. Arterial pressures, cardiac output (CO), and hemorrhage rate were measured. Survival and blood loss were calculated outcome measures.
The difference in survival between the animals left hypotensive (40%) and those receiving normotensive resuscitation (20%) was not significant (p = 0.49). In the animals receiving fluid resuscitation, mean arterial pressure (MAP) and CO increased during the resuscitative phase, but all the animals suffered the same pattern of hemodynamic deterioration in the evaluation phase. Rate of hemorrhage during the resuscitative phase was 20 +/- 5 mL/min in the animals not receiving fluid and 56 +/- 9 mL/min in the animals receiving fluids. Total blood loss was subsequently 20 mL/kg greater in the animals receiving fluids than in the animals without fluid resuscitation.
In this model of continuous uncontrolled hemorrhage, the difference in survival between the animals left hypotensive and the animals receiving fluid resuscitation was not statistically significant. Increases in MAP and CO with fluid resuscitation were transient and were offset by larger volumes of blood loss. In contrast to the aortotomy model (where thrombosis is likely and hypotensive resuscitation has proven beneficial), this model suggests that in continuous bleeding avoiding fluid resuscitation has a much smaller effect on outcome. Much of the benefit from hypotensive resuscitation may depend on having an injury that can stop bleeding.
在已证实出血持续的非控制性出血模型中，确定积极补液与允许性低血压对生存率、失血量和血流动力学的影响。
在该猪模型中，通过置于股动脉和腹腔之间的流量监测分流器对10只动物进行放血。在受伤后10至20分钟的复苏阶段，动物要么不接受补液（n = 5），要么接受80 mL/kg乳酸林格氏液（n = 5），随后进入40分钟的评估阶段。测量动脉压、心输出量（CO）和出血率。计算生存率和失血量作为结果指标。
低血压动物（40%）和接受正常血压复苏动物（20%）的生存率差异无统计学意义（p = 0.49）。在接受液体复苏的动物中，复苏阶段平均动脉压（MAP）和CO升高，但所有动物在评估阶段均出现相同的血流动力学恶化模式。未接受补液的动物复苏阶段出血率为20±5 mL/分钟，接受补液的动物为56±9 mL/分钟。随后，接受补液的动物总失血量比未接受液体复苏的动物多20 mL/kg。
在该持续非控制性出血模型中，低血压动物和接受液体复苏动物的生存率差异无统计学意义。液体复苏导致的MAP和CO升高是短暂的，且被更大的失血量所抵消。与主动脉切开模型（可能发生血栓形成且已证明允许性低血压复苏有益）不同，该模型表明在持续出血时避免液体复苏对结果的影响要小得多。允许性低血压复苏的许多益处可能取决于损伤能否止血。
