Resuscitation with a Bolus of Hypertonic Saline/Dextran Improves Renal Function Following Hemorrhage in Conscious Swine.

摘要

This study was performed to determine whether resuscitation with a single bolus of 7.5% NaCl/6% Dextran 70 (hypertonic saline/dextran, HSD) could restore renal function following hemorrhage. Chronically instrumented, conscious pigs (n=6) were hemorrhaged 28 ml/kg. Mean arterial pressure (MAP) was reduced from 110 + or - 4 to 52 + or - 4 mmHg, cardiac output (CO) from 4.2 + or - 0.3 to 2.2 + or - 0.3 L/min, renal blood flow (RBF) from 238 + or - 16 to 57 + or - 5 ml/min/kidney, glomerular filtration rate (GFR) from 22 + or - 4 to 2 + or - 1 ml/min/kidney, and urine flow (v) from 0.70 + or - 0.30 to 0.03 + or - 0.02 ml/min/kidney. A single, 4 ml/kg bolus injection of HSD increased MAP to 93 + or - 7 mmHg, CO to 3.9 + or - 0.4 L/min, RBF to 191 + or - 20 ml/min/kidney, GFR to 22 + or - 6 ml/min/kidney. These improvements were sustained for 2 hours with no further treatment. Urine flow transiently increased to 0.40 + or - 0.20 ml/min/kidney, but then subsided to 0.20 + or - 0.02 ml/min/kidney at 60 min. Plasma osmolality increased from 275 + or - 4 to 282 + or - 5 mOsm/kg H2O, and plasma sodium increased from 141 + or - 3 to 149 + or - 5 mEq/L. Recovery following administration of an equal volume of normal saline (n=5) was significantly less. Euvolemic animals (n=5) showed no response in MAP, CO, RBF, or GFR when treated with HSD although V, osmotic and sodium excretion increased. These results demonstrate that resuscitation with HSD following hemorrhage not only restores MAP and CO but maintains renal function as well. Keywords: Renal function; HSD; Hemorrhage; Hemorrhagic shock; Hypertonic saline dextran. (kt)