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Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic response and lung water following thermal injury.

机译:晶体和胶体复苏对热损伤后血液动力学反应和肺水疗效的随机试验。

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摘要

To assess the effects of crystalloid and colloid resuscitation on hemodynamic response and on lung water following thermal injury, 79 patients were assigned randomly to receive lactated Ringer's solution or 2.5% albumin-lactated Ringer's solution. Crystalloid-treated patients required more fluid for successful resuscitation than did those receiving colloid solutions (3.81 vs. 2.98 ml/kg body weight/% body surface burn, p less than 0.01). In study phase 1 (29 patients), cardiac index and myocardial contractility (ejection fraction and mean rate of internal fiber shortening, Vcf) were determined by echocardiography during the first 48 hours postburn. Cardiac index was lower in the 12- to 24-hour postburn interval in the crystalloid group, but this difference between treatment groups had disappeared by 48 hours postburn. Ejection fractions were normal throughout the entire study, while Vcf was supranormal (p less than 0.01 vs. normals) and equal in the two resuscitation groups. In study phase 2 (50 patients), extravascular lung water and cardiac index were measured by a standard rebreathing technique at least daily for the first postburn week. Lung water remained unchanged in the crystalloid-treated patients (p greater than 0.10), but progressively increased in the colloid-treated patients over the seven day study (p less than 0.0001). The measured lung water in each treatment group was significantly different from one another (p less than 0.001). Cardiac index increased progressively and identically in both treatment groups over the study period (p less than 0.01). These data refute the existence of myocardial depression during postburn resuscitation and document hypercontractile left ventricular performance. The addition of colloid to crystalloid resuscitation fluids produces no long lasting benefit on total body blood flow, and promotes accumulation of lung water when edema fluid is being reabsorbed from the burn wound.
机译:为了评估晶体和胶体复苏对热损伤后血液动力学反应和肺水的影响,随机分配了79名患者接受乳酸林格氏液或2.5%白蛋白乳酸林格氏液。接受胶体溶液治疗的患者比接受胶体溶液的患者需要更多的液体来进行成功的复苏(3.81比2.98 ml / kg体重/%体表灼伤,p小于0.01)。在研究第一阶段(29例患者)中,在烧伤后的前48小时内通过超声心动图确定了心脏指数和心肌收缩力(射血分数和内部纤维缩短的平均速率,Vcf)。在晶体组中,烧伤后12至24小时的心脏指数较低,但烧伤后48小时,治疗组之间的这种差异已消失。在整个研究中,射血分数是正常的,而Vcf是超正常的(与正常值相比,p小于0.01),并且在两个复苏组中均相等。在研究阶段2(50例患者)中,至少在烧伤后的第一周每天通过标准的呼吸技术测量血管外肺水和心脏指数。在接受晶体治疗的患者中,肺水保持不变(p大于0.10),但是在经过7天的研究中,通过胶体治疗的患者中肺水逐渐增加(p小于0.0001)。每个治疗组中测得的肺水量显着不同(p小于0.001)。在研究期间,两个治疗组的心脏指数均逐渐增加且相同(p小于0.01)。这些数据驳斥了烧伤后复苏过程中心肌抑制的存在,并记录了左心室过度收缩的表现。在晶体复苏液中添加胶体不会对人体总血流产生持久的好处,当从烧伤伤口吸收水肿液时,会促进肺水的积聚。

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