The effect of hypertonic-hyperoncotic fluid on interstinal microcirculation at prehospital situation

本研究旨在评估各种液体对失血性休克中肠道微循环的影响，为院前情景做准备。实验前，将动物随机分为以下实验组：假手术组（无出血的手术准备）；对照组（出血无复苏液）；输血组，输血量与取血量成1:1的关系；HES组，6% HES在生理盐水中（分子量175-220 kDa，取代度0.45-0.55），与移除血容量成1:1关系；AR组，AR溶液与移除血容量呈3:1的关系；HS组：高渗生理盐水（4mL/kg）；HHS组，6% HES 4ml/kg， 7.5%高渗盐水。本研究的主要发现是，虽然所有接受液体治疗的组在到达医院时绒毛的血流量和氧合没有显著差异，但在研究结束时，相当于出血量的HES溶液比其他溶液更有效地改善了出血。小体积HHS对肠道微循环也有良好的影响，但与相当于出血的HES溶液相比，效果持续时间较短。小剂量HHS未能改善肠道微循环的主要原因被认为是与其他研究相比，出血的程度过于严重，无法弥补体积损失。院前现场小体积溶液治疗的建立需要进一步研究HHS的输注量。

The present study was performed to evaluate the effects of various kinds of fluids on microcirculation in the intestine in the hemorrhagic shock, which was prepared for the prehospital scenario. Before the experiment, animals were randomly divided into the following experimental groups: sham group (surgical preparation with no hemorrhage); control group (hemorrhage with no resuscitation fluid); transfusion group, blood in a 1:1 relation to removed blood volume; HES group, 6% HES in normal saline (molecular weight, 175-220 kDa; degree of substitution, 0.45-0.55) in a 1:1 relation to removed blood volume; AR group, AR solution in a 3:1 relation to removed blood volume; HS group, hypertonic saline solution (4mL/kg); HHS group, 4ml/kg of 6% HES in 7.5% hypertonic saline.The main finding in this study is that although all groups that received fluids showed no significant difference in the blood flow and oxygenation in the villi at the time of arrival in hospital, HES solution equivalent to the volume of hemorrhage improved more effectively at the end of study than other solutions. Small volume of HHS also had a good effect on microcirculation in the intestine, but the effect continued for short time compared with HES solution equivalent to the hemorrhage.The main reason why small volume of HHS failed at improving the microcirculation in the intestine is considered to be that the extent of the hemorrhage was too severe to compensate for the volume loss compared with other studies. Further study as to how much volume of HHS should be infused is needed to establish the small volume solution therapy at prehospital scene.