Younes R N, Aun F, Ching C T, Goldenberg D C, Franco M H, Miura F K, Santos S S, Sequeiros I M, Rocha e Silva M, Fujimura I, Birolini D
Department of Surgery, University of São Paulo School of Medicine, Brazil.
Shock. 1997 Feb;7(2):79-83. doi: 10.1097/00024382-199702000-00001.
Hypertonic solutions effectively improve hemodynamic parameters in patients admitted to the emergency room. However, no significant differences in outcome were observed compared with standard isotonic treatment in most previously published studies. This study evaluates pretreatment prognostic factors that predict a beneficial effect of hypertonic solution in patients admitted to the emergency room with hemorrhagic hypovolemia in a prospective double-blind fashion. The patients (n = 212) were randomized upon admission to receive 250 mL intravenous (i.v.) bolus of hypertonic 7.5% NaCl + 6% dextran (HSD, n = 101), or isotonic 0.9% NaCl solutions (IS, n = 111) as the first treatment, followed by standard resuscitation. Pretreatment factors assessed were sex, age, cause of hypovolemia, revised trauma score (RTS), Glasgow index, and mean arterial pressure (MAP) on admission. Both groups were compared for survival at 24 h and 30 days postadmission. Infused volumes were registered. HSD administration significantly increased MAP and reduced i.v. crystalloid infusions to maintain hemodynamic parameters, compared with IS. There was no difference between groups in the number of blood transfusions administered. Overall complication rates in both groups were similar (24%). There was a significant difference (p < .03) in overall (30 days) survival rate between HSD (73%) and IS (64%) groups. The 24 h survival rate was significantly lower in IS (72%) compared with HSD (87%); p < .01. Multivariate analyses showed that RTS and MAP were identified as independent predictors for 24 h survival in the group that received HSD. When evaluated for overall survival rate, hypertonic infusion benefited significantly only patients with MAP < 70 mmHg (p < .01).
高渗溶液可有效改善急诊患者的血流动力学参数。然而，在大多数先前发表的研究中，与标准等渗治疗相比，未观察到结局有显著差异。本研究以前瞻性双盲方式评估了预测高渗溶液对急诊出血性低血容量患者有益作用的预处理预后因素。患者（n = 212）入院时随机接受250 mL静脉推注高渗7.5%氯化钠+ 6%右旋糖酐（HSD，n = 101）或等渗0.9%氯化钠溶液（IS，n = 111）作为首次治疗，随后进行标准复苏。评估的预处理因素包括性别、年龄、低血容量原因、修正创伤评分（RTS）、格拉斯哥指数和入院时的平均动脉压（MAP）。比较两组入院后24小时和30天的生存率。记录输注量。与IS相比，HSD给药显著提高了MAP并减少了维持血流动力学参数所需的静脉晶体液输注量。两组输血次数无差异。两组总体并发症发生率相似（24%）。HSD组（73%）和IS组（64%）的总体（30天）生存率存在显著差异（p < .03）。IS组（72%）的24小时生存率显著低于HSD组（87%）；p < .01。多变量分析表明，RTS和MAP被确定为接受HSD治疗组24小时生存的独立预测因素。在评估总体生存率时，高渗输注仅对MAP < 70 mmHg的患者有显著益处（p < .01）。
