7.5% saline and 7.5% saline/6% dextran for hypovolemic shock.
7.5% saline and 7.5% saline/6% dextran for hypovolemic shock.
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DOI：
10.1097/ta.0b013e31821a559a
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发表时间：
2011-05
期刊：
影响因子：
--
通讯作者：
Bulger EM
中科院分区：
文献类型：
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作者：
Bulger EM
外伤性失血性休克的传统复苏包括从院前开始静脉给予等渗（生理盐水[NS]）或微低渗（乳酸林格[LR]）溶液。虽然没有定论，但先前的动物和人类研究表明，使用高渗盐水（7.5%）溶液进行替代复苏可能会降低这些患者的死亡率。高渗盐-葡聚糖（HSD）（7.5%的生理盐水加6%的葡聚糖-70）作为一种可替代的复苏液用于重伤患者进行了研究，1-6 HSD可导致血清渗透压升高，从而导致液体从间质重新分配到血管内空间。这种重新分配导致循环血管内容量的快速恢复，与等渗或低渗晶体溶液相比，所需的液体体积更小，并且减少了血管外体积的积累。HSD的渗透作用已被证明可以降低脑损伤患者的颅内压。因此，全身灌注增加（增加脑灌注）和颅内压降低的结合可能使继发性脑损伤的进展最小化。此外，最近的研究表明，高渗性对限制循环炎症细胞的促炎反应有影响。7,8因此，通过调节全身缺血/再灌注损伤后过度的免疫炎症反应，高渗溶液可能具有额外的有益作用。因此，高渗复苏有可能影响外伤后的早期和晚期死亡率。右旋糖酐最初被添加到这些溶液中是为了延长高渗性的循环作用。然而，在早期临床试验之后，一些临床前研究表明，使用HS而不是HSD可以减少炎症性器官损伤。9-13去除葡聚糖成分可能会增强该溶液的抗炎作用，从而降低损伤后晚期并发症的风险。
Conventional resuscitation of traumatic hemorrhagic shock involves the intravenous administration of isotonic (normal saline [NS]) or slightly hypotonic (lactated Ringer’s [LR]) solution beginning in the prehospital setting. Although not conclusive, prior animal and human studies have suggested that alternative resuscitation with hypertonic saline (HS)(7.5%) solutions may reduce mortality in these patients. Hypertonic saline-dextran (HSD)(7.5% saline with 6% dextran-70) has been investigated as an alternative resuscitation fluid in critically injured patients, 1–6 HSD results in an increase in serum osmotic pressure, which leads to the redistribution of fluid from the interstitial to the intravascular space. This redistribution leads to rapid restoration of circulating intravascular volume, with a smaller volume of fluid required compared with isotonic or hypotonic crystalloid solutions and decreased accumulation of extravascular volume. The osmotic effect of HSD has been shown to reduce intracranial pressure in patients with brain injury. Thus, the combination of increased systemic perfusion, which increases cerebral perfusion, and a decrease in the intracranial pressure may minimize the progression of secondary brain injury. In addition, recent studies have demonstrated an impact of hypertonicity on limiting the proinflammatory response of circulating inflammatory cells. 7, 8 Thus, hypertonic solutions may have additional beneficial effects by modulating the excessive immunoinflammatory response after systemic ischemia/reperfusion injury. Hypertonic resuscitation, therefore, has the potential to impact both early and late mortality after traumatic injury.Dextran was initially added to these solutions in an effort to prolong the circulatory effect of hypertonicity. Subsequent to the early clinical trials, however, several preclinical studies demonstrated the reduction of inflammatory organ injury using HS rather than HSD. 9–13 Removal of the dextran component may enhance the anti-inflammatory effects of this solution, which could reduce the risk of late complications after injury.