THE HEMODYNAMIC AND CARDIOVASCULAR EFFECTS OF NEAR-DROWNING IN HYPOTONIC, ISOTONIC, OR HYPERTONIC SOLUTIONS
THE HEMODYNAMIC AND CARDIOVASCULAR EFFECTS OF NEAR-DROWNING IN HYPOTONIC, ISOTONIC, OR HYPERTONIC SOLUTIONS
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DOI：
10.1016/s0196-0644(89)80927-8
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发表时间：
1989-10-01
影响因子：
6.2
通讯作者：
PHILLIPS, JM
中科院分区：
文献类型：
--
作者：
ORLOWSKI, JP;ABULLEIL, MM;PHILLIPS, JM
据推测，由于吸入的水的渗透压较低，在淡水中接近溺水可能会导致血液稀释和血容量过多。相反，由于海水的高渗性，在海水中接近溺水可能会导致低血容量性休克。我们评估了将 20 mL/kg 不同张力的溶液（无菌水、0.225%氯化钠、0.45%氯化钠、生理盐水、2%氯化钠和 3%氯化钠）滴入麻醉犬肺部的血流动力学效应，并将结果与缺氧 5 分钟的对照动物的结果进行比较。与缺氧对照相比，低渗、等渗、高渗溶液的血流动力学效应没有差异。无论采用何种溶液，心输出量立即下降，肺毛细血管楔压、中心静脉压和肺血管阻力增加，这与缺氧对照的变化在统计学上相同（P > .02）。同样，肺部的有效动态顺应性急剧下降，溶液之间无法区分，并且与缺氧对照没有统计学差异（P > .10）。肺毛细血管楔压和中心静脉压在十分钟时达到峰值，然后在四小时内逐渐下降，与吸入液体的张力无关。在整个实验过程中，心输出量和肺的有效动态顺应性迅速下降并保持低迷状态，并且肺血管阻力在整个四个小时的研究过程中逐渐恶化。缺氧对照也出现了类似的结果。接近溺水和吸入水时发生的心血管变化并不取决于吸入液体的张力，而是缺氧的直接结果。
It has been postulated that near-drowning in fresh water may cause hemodilution and hypervolemia due to the hypotonicity of the aspirated water. In contrast, near-drowning in seawater, because of its hypertonicity, may lead to hypovolemic shock. We evaluated the hemodynamic effects of the instillation of 20 mL/kg of solutions of various tonicities (sterile water, 0.225% sodium chloride, 0.45% sodium chloride, normal saline, 2% sodium chloride, and 3% sodium chloride) into the lungs of anesthetized dogs and compared the results with those for control animals who were made anoxic for five minutes. There was no difference in the hemodynamic effects of hypotonic, isotonic, of hypertonic solutions when compared with anoxic controls. There was an immediate fall in cardiac output and increase in pulmonary capillary wedge pressure, central venous pressure, and pulmonary vascular resistance, regardless of the solution, which was statistically the same as the changes in the anoxic controls (P > .02). Likewise, the effective dynamic compliance of the lungs decreased precipitously, was indistinguishable between solutions, and was not statistically different from the anoxic controls (P > .10). The pulmonary capillary wedge pressure and central venous pressure peaked at ten minutes and then declined gradually over four hours independent of the tonicity of the aspirated fluid. The cardiac output and effective dynamic compliance of the lung dropped rapidly and remained depressed throughout the experiment, and the pulmonary vascular resistance gradually worsened throughout the four hours of study. Similar results occurred with the anoxic controls. The cardiovascular changes that occur with near-drowning and aspiration of water are not dependent on the tonicity of the aspirated fluid but are the direct result of anoxia.