Riddez L, Johnson L, Hahn R G
Department of Surgery, Söder Hospital, and the Swedish National Defense Research Establishment, Stockholm.
J Trauma. 1998 Mar;44(3):433-9. doi: 10.1097/00005373-199803000-00001.
To study the effect of graded crystalloid fluid resuscitation on central hemodynamics and outcome after intra-abdominal hemorrhage.
Ten minutes after a 5-mm long laceration was produced in the infrarenal aorta, 32 pigs were randomized to receive either no fluid or Ringer's solution in the proportion 1:1, 2:1, or 3:1 to the expected amount of blood lost per hour (26 mL kg[-1]) over 2 hours. The hemodynamics were studied using arterial and pulmonary artery catheters and four blood flow probes placed over major blood vessels.
During the first 40 minutes after the injury, the respective blood flow rates in the distal aorta were 39% (no fluid), 41% (1:1), 56% (2:1), and 56% (3:1) of the baseline flow. Fluid resuscitation increased cardiac output but had no effect on arterial pressure, oxygen consumption, pH, or base excess. Rebleeding occurred only with the 2:1 and 3:1 fluid programs. Survival was highest with the 1:1 and 2:1 programs.
Crystalloid fluid therapy improved the hemodynamic status but increased the risk of rebleeding. Therefore, a moderate fluid program offered the best chance of survival.
研究分级晶体液复苏对腹腔内出血后中心血流动力学及预后的影响。
在肾下腹主动脉造成5毫米长的撕裂伤10分钟后，将32头猪随机分为四组，分别不给予液体，或按每小时预期失血量（26 mL·kg⁻¹）的1:1、2:1或3:1的比例给予林格氏液，持续2小时。使用动脉和肺动脉导管以及置于主要血管上的四个血流探头研究血流动力学。
在受伤后的前40分钟内，远端主动脉的血流速率分别为基线血流的39%（不给予液体）、41%（1:1）、56%（2:1）和56%（3:1）。液体复苏增加了心输出量，但对动脉压、氧耗、pH值或碱剩余无影响。仅在2:1和3:1的液体方案中发生了再出血。1:1和2:1方案的存活率最高。
晶体液治疗改善了血流动力学状态，但增加了再出血的风险。因此，适度的液体方案提供了最佳的生存机会。
