Hypotensive resuscitation of multiple hemorrhages using crystalloid and colloids
Hypotensive resuscitation of multiple hemorrhages using crystalloid and colloids
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DOI：
10.1097/01.shk.0000135255.59817.8c
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发表时间：
2004-09-01
期刊：
影响因子：
3.1
通讯作者：
Kramer, GC
中科院分区：
文献类型：
--
作者：
Rafie, AD;Rath, PA;Kramer, GC
低血压复苏被认为是穿透伤现场复苏的较好方法。我们的假设是，使用晶体或胶体的快速复苏提供了等同或改善的代谢功能，同时减少了出血复苏的总体液体需求。我们比较了使用乳酸林格氏液（LR）进行出血的扩张复苏和正常血压复苏，以及使用含6%羟乙基淀粉的等渗缓冲盐水进行扩张复苏。将装有仪器的清醒绵羊分三次单独采血，T0时为25 mL/kg，T50和T70时均为5 mL/kg。复苏开始于T30，持续至T180。采用LR或Hex，使用LR-65和Hex-65治疗方案的闭环复苏（CPR）系统进行低血压复苏至平均动脉压（MAP）65 mmHg。对照治疗方案是用LR复苏至90 mmHg的MAP目标，LR-90。所有治疗方案均成功复苏至接近目标水平。在第二次和第三次眼睑闭合期间，两个治疗方案中的动物死亡，一个在LR-65治疗方案中，一个在Hex-65治疗方案中。LR-90、LR-65和Hex-65治疗组的平均输注体积分别为61.4 +/- 11.3、18.0 +/- 5.9 * 和11.6 +/- 1.9* mL/kg（*P < 0.05，相对于LR-90）。LR-90、LR-65和Hex-65处理组的平均最小碱过量（BE）值分别为+1.9 +/- 1.4、-5.8 +/- 4.3和-5.9 +/- 4.0 mEq/L。与正常血压复苏相比，低血压复苏与LR大大降低了容量需求，Hex实现了额外的容量节省。然而，BE值降低的趋势和仅在扩张性治疗方案中发生的死亡表明，复苏至65 mmHg的目标MAP可能太低，无法获得最佳结局。
Hypotensive resuscitation has been advocated as a better means to perform field resuscitation of penetrating trauma. Our hypothesis is that hypotensive resuscitation using either crystalloid or colloid provides equivalent or improved metabolic function while reducing the overall fluid requirement for resuscitation of hemorrhage. We compared hypotensive and normotensive resuscitation of hemorrhage using lactated Ringer's (LR) with hypotensive resuscitation using Hextend(TM) (Hex), 6% hetastarch in isotonic buffered saline. Instrumented conscious sheep were hemorrhaged in three separate bleeds, 25 mL/kg at T0 and 5 mL/kg at both T50 and T70. Resuscitation was started at T30 and continued until T180. Hypotensive resuscitation to a mean arterial pressure (MAP) of 65 mmHg was performed with LR or Hex using a closed-loop resuscitation (CLR) system for a LR-65 and Hex-65 treatment protocol. A control treatment protocol was resuscitation with LR to a MAP target of 90 mmHg, LR-90. All treatment protocols were successfully resuscitated to near target levels. Two animals in the hypotensive treatment protocols died during the second and third bleedings, one in the LR-65 and one in the Hex-65 treatment protocol. Mean infused volumes were 61.4 +/- 11.3, 18.0 +/- 5.9,* and 11.6 +/- 1.9* mL/kg in the LR-90, LR-65, and Hex-65 treatments, respectively (*P < 0.05 versus LR-90). Mean minimum base excess (BE) values were +1.9 +/- 1.4, -5.8 +/- 4.3, and -5.9 +/- 4.0 mEq/L in the LR-90, LR-65, and Hex-65 treatments, respectively. Hypotensive resuscitation with LR greatly reduced volume requirements as compared with normotensive resuscitation, and Hex achieved additional volume sparing. However, trends toward lower BE values and the occurrence of deaths only in the hypotensive treatment protocols suggest that resuscitation to a target MAP of 65 mmHg may be too low for optimal outcomes.