高渗盐溶液治疗创伤后微血管、大血管血容量和总血容量的变化

目的：探讨烧伤冲击伤复合伤后一次性输入高渗盐溶液抗休克治疗的效果及机制。方法：实验采用狗烧伤冲击伤复合伤模型，观察复合伤后２小时一次性分别静脉给予７．５％ＮａＣｌ＋６％葡聚糖７０（ＨＳＤ）和乳酸林格氏液（ＬＲ）治疗后血压、心输出量、红细胞压积及血浆粘度等的变化，并在此基础上计算微血管血容量、大血管血容量和总血容量的变化。结果：复合伤后血压和心输出量明显降低，红细胞压积显著升高。早期使用ＨＳＤ治疗较ＬＲ能更显著地回升血压和心输出量，降低红细胞压积，非常显著地增加总血容量，其中以大血管血容量增加为主；而ＬＲ治疗则以微血管血容量增加为主。结论：ＨＳＤ治疗通过显著增加大血管血容量，维持微血管血容量，因而有效恢复血压和心输出量、减轻组织水肿，优于ＬＲ治疗。

Effect of hypertonic saline solution on total blood volume,microvascular and macrovascular blood volume after burnblast combined injury

Objective:To study the effect of antishock ther apy with a bolus of hypertonic saline solution on burn blast combined injury and its mechanism in dogs.Methods:Animals were treated with a bolus of 7 5% hypertonic saline/6% dextran 70 solution (HSD) or Lactated Ringer's solution (LR) at 2 hours after burnblast combined injury.Blood pressure,cardiac output,hematocrit and plasma viscosity were measured and microvascular,macrovascular blood volume and total blood volume were calculated accordingly.Results:It was shown that blood pressure and cardiac output significantly decreased,but hematocrit significantly increased after injury.Early treatment with HSD could significantly increase blood pressure and cardiac output,decrease hematocrit,and recover total blood volume compared with LR group.The increase of blood volume was mainly in macrovascular blood volume in HSD group,and microvascular blood volume in LR group respectively.Conclusions:These data suggest that treatment with HSD can markedly improve blood pressure and cardiac output,attenuate tissue edema through increasing both macrovascular blood volume and microvascular blood volume.Also,treatment with HSD appears to be superior to that of LR.