Comparisons of normal saline and lactated Ringer's resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock
Comparisons of normal saline and lactated Ringer's resuscitation on hemodynamics, metabolic responses, and coagulation in pigs after severe hemorrhagic shock
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DOI：
10.1186/1757-7241-21-86
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发表时间：
2013-12-11
影响因子：
3.3
通讯作者：
Dubick, Michael A.
中科院分区：
文献类型：
--
作者：
Martini, Wenjun Z.;Cortez, Douglas S.;Dubick, Michael A.
背景资料：创伤护理的持续改进现在建议早期使用血液制品作为损害控制复苏的一部分，但通常这些产品在遥远的前线战场上无法获得。对于军队来说，关于生理盐水（NS）与乳酸林格氏液（LR）的有效性的问题继续出现。方法：20只猪随机分为对照组（n = 6）、LR组（n = 7）和NS组（n = 7）。在LR和NS组中，通过使用计算机控制的泵从左股动脉移除血液来诱导60%估计总血容量的出血。然后用3倍流血的量的LR或NS复苏，使平均动脉压（MAP）与LR组相同。结果：失血后MAP下降，但在复苏后1h内LR（119 +/- 7 ml/kg）或NS（183 +/- 9 ml/kg）恢复至基线水平（BL），P < 0.05。碱过剩（BE）减少出血;复苏LR恢复BE，但没有与NS。NS和LR组总外周阻力均降低，NS组下降幅度更大。NS组血清钾升高，LR组血清钾升高不明显。LR和NS之间的凝血变化相似。结论：由于其血管扩张作用以及代谢性酸中毒和高钾血症的风险，NS在复苏中可能不如LR。
Background: Ongoing improvements in trauma care now recommend earlier use of blood products as part of damage control resuscitation, but generally these products are not available at far forward battlefield locations. For the military, questions continue to arise regarding efficacy of normal saline (NS) vs. lactated Ringer's (LR). Thus, this study compared the effects of LR and NS after severe hemorrhage in pigs.Methods: 20 anesthetized pigs were randomized into control (n = 6), LR (n = 7), and NS (n = 7) groups. Hemorrhage of 60% estimated total blood volume was induced in LR and NS groups by removing blood from the left femoral artery using a computer-controlled pump. Afterwards, the pigs were resuscitated with either LR at 3 times the bled volume or the volume of NS to reach the same mean arterial pressure (MAP) as in LR group. Hemodynamics were measured hourly and blood samples were taken at baseline (BL), 15 min, 3 h and 6 h after resuscitation to measure changes in coagulation using thrombelastograph(R).Results: MAP was decreased by hemorrhage but returned to BL within 1 h after resuscitation with LR (119 +/- 7 ml/kg) or NS (183 +/- 9 ml/kg, p < 0.05). Base excess (BE) was decreased by hemorrhage; resuscitation with LR recovered BE but not with NS. Total peripheral resistance was decreased with NS and LR, with a larger drop shown in NS. Serum potassium was increased with NS, but not affected with LR. Coagulation changes were similar between LR and NS.Conclusions: NS may be inferior to LR in resuscitation due to its vasodilator effects and the risks of metabolic acidosis and hyperkalemia.