Dynamic fluid redistribution in hyperosmotic resuscitation of hypovolemic hemorrhage.
Dynamic fluid redistribution in hyperosmotic resuscitation of hypovolemic hemorrhage.
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低血容量出血高渗复苏中的动态液体再分配。
DOI：
10.1152/ajpheart.1988.255.3.h629
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发表时间：
1988
期刊：
影响因子：
--
通讯作者：
Intaglietta,M
中科院分区：
文献类型：
--
作者：
Mazzoni,MC;Borgström,P;Arfors,KE;Intaglietta,M
一个数学描述出血后血容量恢复与复苏液体，特别是高渗溶液，是提出。它是基于不可逆热力学输运方程和已知的生理数据。该模型显示，在20%出血后，快速加入高渗(7.5% NaCl)-高渗（6%葡聚糖70）溶液，相当于流出血容量的七分之一，可在1分钟内恢复血容量。13个麻醉家兔的全身红细胞压比、血红蛋白浓度和血浆渗透压的测量证实了这一预测。模型显示，在高渗输注后，水首先从红细胞和内皮细胞转移到血浆中，然后从间质细胞和组织细胞转移到血浆中。血容量的增加是暂时的；然而，在相同输注速率下，与等渗液体相比，它发生的时间要短得多，并且部分由葡聚糖70维持。我们推测，在高渗输注过程中，同时发生的血液稀释和内皮细胞收缩导致毛细血管水力阻力降低，这种影响在内皮肿胀的毛细血管中更为显著。我们的研究结果支持在高渗复苏过程中渗透机制在快速恢复血容量和改善组织灌注方面的重要作用。
A mathematical description of blood volume restoration after hemorrhage with resuscitative fluids, particularly hyperosmotic solutions, is presented. It is based on irreversible thermodynamic transport equations and known physiological data. The model shows that after a 20% hemorrhage, the rapid addition of a hypertonic (7.5% NaCl)-hyperoncotic (6% Dextran 70) solution amounting to one-seventh of the shed blood volume reestablishes blood volume within 1 min. Measurements of systemic hematocrit, hemoglobin concentration, and plasma osmolality taken from 13 experiments on anesthetized rabbits verify this prediction. The model shows that immediately after hyperosmotic infusion, water shifts into the plasma first from red blood cells and endothelium and then from the interstitium and tissue cells. The increase in blood volume is transitory; however, it occurs in a fraction of the time compared with isoosmotic fluids at the same infusion rate and is partially sustained by Dextran 70. We theorize that the concurrent hemodilution and endothelial cell shrinkage during hyperosmotic infusion lead to a decreased capillary hydraulic resistance, an effect that is even more significant in capillaries with swollen endothelium. Our results support the significant role of an osmotic mechanism during hyperosmotic resuscitation in quickly restoring blood volume with the added benefit of improved tissue perfusion.