Sakles J C, Sena M J, Knight D A, Davis J M
Division of Emergency Medicine, University of California, Davis Medical Center, Sacramento, USA.
Ann Emerg Med. 1997 Mar;29(3):392-9. doi: 10.1016/s0196-0644(97)70352-4.
To determine the effects of early fluid resuscitation on the rate, volume, and duration of hemorrhage using a sheep model of uncontrolled pulmonary vascular hemorrhage.
Sixteen adult sheep were anesthetized and fitted with catheters to measure systemic and pulmonary artery pressures. A branch of the pulmonary vein was then lacerated through an anterolateral thoracotomy, and a chest tube was inserted to monitor hemorrhage volume. Eight animals were assigned to the immediate fluid (IF) resuscitation group and were given 30 mL/kg of lactated Ringer's solution over a period of 10 minutes; this treatment was repeated once if normotension was not achieved. The other eight animals received no fluid (NF) and served as nonresuscitated controls.
The IF animals had a mean hemorrhage volume of 3,494 +/- 1,525 mL, compared with 1,594 +/- 689 mL in the NF group (P < .001). Hemorrhage stopped spontaneously in the NF group at a mean of 29 +/- 9 minutes but took 48 +/- 11 minutes in the IF group (P = .003). During the 20-minute period of fluid resuscitation, the IF animals bled at twice the rate of the NF animals (90 +/- 33 versus 46 +/- 22 mL/minute, respectively; P = .02). During the 10-minute interval after fluids were administered, the rate of hemorrhage remained brisk at 73 +/- 57 mL/minute in the IF group but virtually stopped in the NF group (6 +/- 7 mL/minute; P = .02).
In this sheep model of uncontrolled pulmonary vascular hemorrhage, immediate fluid resuscitation significantly increased the rate, volume, and duration of hemorrhage. The vigorous administration of fluids to patients with penetrating chest trauma has the potential to significantly increase blood loss.
使用未控制的肺血管出血绵羊模型，确定早期液体复苏对出血速率、出血量和出血持续时间的影响。
16只成年绵羊麻醉后插入导管以测量体动脉和肺动脉压力。然后通过前外侧开胸术撕裂肺静脉的一个分支，并插入胸管以监测出血量。8只动物被分配到即刻液体（IF）复苏组，在10分钟内给予30 mL/kg乳酸林格氏液；如果未达到正常血压，则重复此治疗一次。另外8只动物不接受液体（NF），作为未复苏的对照。
IF组动物的平均出血量为3494±1525 mL，而NF组为1594±689 mL（P<.001）。NF组出血在平均29±9分钟时自发停止，而IF组则需要48±11分钟（P=.003）。在液体复苏的20分钟期间，IF组动物的出血速率是NF组动物的两倍（分别为90±33与46±22 mL/分钟；P=.02）。在给予液体后的10分钟间隔内，IF组出血速率仍保持在73±57 mL/分钟，而NF组几乎停止出血（6±7 mL/分钟；P=.02）。
在这个未控制的肺血管出血绵羊模型中，即刻液体复苏显著增加了出血速率、出血量和出血持续时间。对穿透性胸部创伤患者大力输注液体有可能显著增加失血量。
