Kröll W, Gassmayr S E, Izmail S, List W F
Universitäts-Klinik für Anästhesiologie und Intensivmedizin, Karl-Franzens-Universität, Graz.
Praxis (Bern 1994). 1998 May 13;87(20):683-9.
Hypertonic-hyperoncotic solutions are a supplementary possibility in the acute treatment of hypovolemia. The main mechanism of action of this solution is, induced by the tonicity of the infusion (approximately 2400 mOsm/l), the transcapillary fluid shift from the intracellular and interstitial to the intravascular compartment. Additionally the fluidity of blood is improved (due to an increase in the diameter of the capillaries), the adherence of leucocytes to the endothelial wall is reduced, and the arteriolar vasomotion is restarted. Due to the available prehospital and clinical results it can be concluded, that hypertonic-hyperoncotic solutions offer advantages compared to conventional fluid therapy regimes: rapid stabilization of hemodynamics, reduction of posttraumatic volume deficiency, of posttraumatic edema and of posttraumatic complications and an improvement of the outcome of the patients. If the therapeutic recommendations are followed, such as a dose of 4 ml/kg body weight, infusion time of about 3-5 minutes and after the end of the infusion application of colloids or crystalloids in an amount as needed, no side effects will occur. Only immediately after the end of infusion sodium, chloride and osmolarity will slightly increase, however these parameters will normalize within the first posttraumatic day. Hypertonic-hyperoncotic solutions are trigger-solutions, as with the infusion of these types of solution it is possible to restore hemodynamics adequately and to prevent shock-induced complications.
高渗 - 高渗胶体溶液是急性低血容量治疗中的一种补充选择。该溶液的主要作用机制是，由输注液的张力（约2400mOsm/l）诱导，使液体从细胞内和间质向血管内间隙进行跨毛细血管转移。此外，血液流动性得到改善（由于毛细血管直径增加），白细胞与内皮壁的黏附减少，小动脉血管运动恢复。根据现有的院前和临床结果可以得出结论，与传统的液体治疗方案相比，高渗 - 高渗胶体溶液具有优势：能快速稳定血流动力学，减少创伤后容量不足、创伤后水肿和创伤后并发症，并改善患者的预后。如果遵循治疗建议，如剂量为4ml/kg体重、输注时间约3 - 5分钟，且输注结束后根据需要应用胶体或晶体液，则不会出现副作用。仅在输注结束后立即，钠、氯和渗透压会略有升高，但这些参数会在创伤后的第一天内恢复正常。高渗 - 高渗胶体溶液是触发溶液，因为输注这类溶液能够充分恢复血流动力学并预防休克引起的并发症。
