The Harmful Effects of Hypertonic Sodium Lactate Administration in Hyperdynamic Septic Shock
The Harmful Effects of Hypertonic Sodium Lactate Administration in Hyperdynamic Septic Shock
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高渗乳酸钠给药对高动力感染性休克的有害影响
DOI：
10.1097/shk.0000000000000684
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发表时间：
2016
期刊：
影响因子：
3.1
通讯作者：
J. Vincent
中科院分区：
文献类型：
--
作者：
F. Su;K. Xie;Xinrong He;D. Orbegozo;K. Hosokawa;E. Post;K. Donadello;F. Taccone;J. Creteur;J. Vincent
摘要 高渗乳酸钠（HTL）可扩大血管内容量，并可能为脓毒症中的细胞代谢提供替代底物。我们比较了 HTL、高渗盐水 (HTS)、0.9%（“正常”）盐水 (NS) 和乳酸林格氏液 (RL) 对麻醉、机械通气的成年母羊的血流动力学、舌下和肾脏微循环、肾脏、肠系膜和脑灌注、肾脏和脑代谢以及存活率的影响。动物（每组 7 只）被随机分配，在诱导粪便性腹膜炎后 2、6 和 10 小时接受 3 mL/kg 0.5 M HTL、3 mL/kg 3% HTS、10.8 mL/kg NS 或 10.8 mL/kg RL 推注（超过 15 分钟），随后 2 小时输注量为 1mL/kg/h（HTL/HTS 组）或 3.6mL/kg/h（NS/RL 组）。在整个实验过程中，动物还接受 RL 和羟乙基淀粉（比例 1:1）滴定，以将肺动脉闭塞压维持在基线水平。观察动物直至其自然死亡。从 4 小时开始，HTL 和 HTS 组的体液平衡低于其他组。在前 12 小时内，各组之间的血流动力学变量相似，但此后 HTL 组的血压和心功能下降更为明显。 HTL组舌下和肾脏微循环异常发生较早。 HTL 组的肾脏和脑灌注下降更快。 HTL（17小时）和NS（16小时）组的中位生存时间显着短于HTS（22小时）或RL（20小时）组（P=0.0029）。总之，在败血性休克的绵羊模型中，施用 HTL 与较早发生的组织灌注受损和较短的生存时间相关。这些观察结果引起了人们对 HTL 在感染性休克中的使用的担忧。
ABSTRACT Hypertonic sodium lactate (HTL) expands intravascular volume and may provide an alternative substrate for cellular metabolism in sepsis. We compared the effects of HTL, hypertonic saline (HTS), 0.9% (“normal”) saline (NS) and Ringer's lactate (RL) on hemodynamics, sublingual and renal microcirculation, renal, mesenteric and brain perfusion, renal and cerebral metabolism, and survival in anesthetized, mechanically ventilated, adult female sheep. Animals (7 in each group) were randomized to receive a bolus (over 15-min) of 3 mL/kg 0.5 M HTL, 3 mL/kg 3% HTS, 10.8 mL/kg NS, or 10.8 mL/kg RL at 2, 6, and 10 h after induction of fecal peritonitis, followed by 2-h infusions of 1 mL/kg/h (HTL/HTS groups) or 3.6 mL/kg/h (NS/RL groups). Animals also received RL and hydroxyethyl starch (ratio 1:1) titrated to maintain pulmonary artery occlusion pressure at baseline levels throughout the experiment. Animals were observed until their spontaneous death. Fluid balance was lower in the HTL and HTS groups than in the other groups from 4 h. Hemodynamic variables were similar among groups during the first 12 h, but thereafter the HTL group had more pronounced decreases in blood pressure and cardiac function. Sublingual and renal microcirculatory abnormalities occurred earlier in the HTL group. Kidney and brain perfusion decreased more rapidly in the HTL group. Median survival times were significantly shorter in the HTL (17 h) and NS (16 h) groups than in the HTS (22 h) or RL (20 h) groups (P = 0.0029). In conclusion, in an ovine model of septic shock, administration of HTL was associated with earlier onset impaired tissue perfusion and shorter survival time. These observations raise concerns about use of HTL in septic shock.
失血性休克中的毛细血管狭窄可通过高渗盐水-右旋糖酐回输来纠正。
DOI：
--
发表时间：
1990
期刊：
Circulatory shock
影响因子：
--
作者：
Mazzoni,MC;Borgström,P;Intaglietta,M;Arfors,KE
通讯作者：
Arfors,KE
影响因子：
3.8
作者：
Zakaria, El Rasheid;Tsakadze, Nina L.;Garrison, R. Neal
通讯作者：
Garrison, R. Neal
影响因子：
2.2
作者：
Whelan, Sean P.;Carchman, Evie H.;Kautza, Benjamin;Nassour, Ibrahim;Mollen, Kevin;Escobar, Daniel;Gomez, Hernando;Rosengart, Matthew A.;Shiva, Sruti;Zuckerbraun, Brian S.
通讯作者：
Zuckerbraun, Brian S.