References

rmt

Общая реаниматология

General Reanimatology

1813-97792411-7110

FSBI "SRIGR" RAMS

10.15360/1813-9779-2012-2-61

rmt-234

Research Article

ОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯ

REVIEWS & SHORT COMMUNICATIONS

Использование гипертонического раствора хлорида натрия при операциях в условиях искусственного кровообращения

Use of Hypertonic Sodium Chloride Solution at Surgery under Extracorporeal Circulation

Ломиворотов

В. В.

Lomivorotov

V. V.

Фоминский

Е. В.

Fominsky

E. V.

ghfrm@rambler.ru

Непомнящих

В. А.

Nepomnyashchikh

V. A.

2012

20042012

Том VIII № 2 2012 г.

6161

2012

Ломиворотов В.В., Фоминский Е.В., Непомнящих В.А.

Lomivorotov V.V., Fominsky E.V., Nepomnyashchikh V.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.reanimatology.com/rmt/article/view/234

Представлен анализ литературы о различных аспектах применения гипертонического раствора хлорида натрия при операциях в условиях искусственного кровообращения в кардиохирургической практике. Показано, что гипертонический раствор уменьшает положительный баланс жидкости в периоперационном периоде, увеличивает сердечный выброс с одновременным снижением сосудистого сопротивления, улучшает оксигенирующую функцию легких, способствует нормализации тканевого кровообращения, а также неврологического статуса у пациентов, подвергшихся искусственной перфузии. Представлены данные о его влиянии на иммунную систему и эндотелий капилляров. Предложена необходимость исследований влияния гипертонического раствора на частоту развития осложнений и летальность при операциях в условиях искусственного кровообращения, а также его использование при длительном искусственном кровообращении. Ключевые слова: гипертонический раствор, хлорид натрия, искусственное кровообращение.

The paper analyzes the data available in the references on different aspects of using hypertonic sodium chloride solution during surgery under extracorporeal circulation in cardiosurgical care. The hypertonic solution is shown to lower positive fluid balance in the perioperative period, to increase cardiac output with simultaneously decreased vascular resistance, to improve lung oxygenating function, and to normalize tissue blood circulation and neurological status in patients exposed to artificial perfusion. There is evidence for its effect on the immune system and capillary endothelium. It is suggested that it is necessary to study the effect of the hypertonic solution on the incidence of complications and death rates during surgery under extracorporeal circulation and it is proposed to use the solution under long-term extracorporeal circulation. Key words: hypertonic saline, sodium chloride, extracorporeal circulation.

References1

Hirleman E., Larson D. F.

Olthof C. G., Jansen P. G., de Vries J. P. et al.Interstitial fluid volume during cardiac surgery measured by means of a non-invasive conductivity technique. Acta Anaesthesiol. Scand. 1995; 39 (4): 508—51

von Spiegel T., Giannaris S., Wietasch G. J. et al.Effects of dexametha-sone on intravascular and extravascular fluid balance in patients undergoing coronary bypass surgery with cardiopulmonary bypass. Anesthesiology 2002; 96 (4): 827—834.

Toraman F., Evrenkaya S., Yuce M. et al.Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome. Perfusion 2004; 19 (2): 85—91.

McAlister V., Burns K.E., Znajda T., Church B.Hypertonic saline for peri-operative fluid management. Cochrane Database Syst. Rev. 2010; 1: CD005576.

Silbert S.The treatment of tromboangiitisobliterans by intravenous injection of hypertonic salt solution. JAMA 1926; 86 (23): 1759—1761.

Monafo W. W.The treatment of burn shock by the intravenous and oral administration of hypertonic lactated saline solution. J. Trauma 1970; 10 (7): 575—586.

Velasco I. T., Pontieri V., Rocha e Silva M. Jr., Lopes O. U.Hyperosmotic NaCl and severe hemorrhagic shock. Am. J. Physiol. 1980; 239 (5): H664—H673.

De Fellipe J. Jr., Timoner J., Velasco I. T. et al.Treatment refractory hypovolaemic shock by 7,5% sodium chloride injections. Lancet 1980; 2 (8202): 1002—1004.

Committee on Fluid Resuscitation for Combat Casualties. Executive summary. In: Pope A., French G., Longnecker D.E. (eds.). Fluid Resuscitation. Washington: National Academy Press; 1999. 1—7.

Жбанников П. С., Забусов А. В., Михин Д. В., Ганерт А. Н.Коррекция гемодинамики гипертоническим раствором хлорида натрия при критических состояниях. Общая реаниматология 2007; III (5—6): 178—181.

Kreimeier U., Bruckner U. B., Niemczyk S., Messmer K.Hyperosmotic saline dextran for resuscitation from traumatic-hemorrhagic hypotension: effect on regional blood flow. Circ. Shock 1990; 32 (2): 83—99.

Rocha e Silva M., Velasco I. T., Nogueria da Silva R. I. et al.Hyperosmotic sodium salts reverse severe hemorrhagic shock: other solutes do not. Am. J. Physiol. 1987; 253 (4 Pt 2): H751—H762.

Mouren S., Delayance S., Mion G. et al.Mechanisms of increased myocardial contractility with hypertonic saline solutions in isolated blood perfused heart. Anesth. Analg. 1995; 81 (4): 777—782.

Bassani J. W., Bassani R. A., Rocha e Silva M.Inotropic effect of hyper-osmotic NaCl solutions on the isolated rat cardiac tissue. Arch. Int. Physiol. Biochim. 1990; 98 (6): 397—402.

Яковлев А. Ю., Емельянов Н. В., Мухина И. В. и соавт.Выбор инфу-зионного препарата для профилактики полиорганной недостаточности при острой массивной кровопотере (экспериментальное исследование). Общая реаниматология 2010; VI (3): 48—51.

Goertz A. W., Mehl T., Lindner K. H. et al.Effect of 7,2% hypertonic saline/6% hetastarch on left ventricular contractility in anesthetized humans. Anesthesiology 1995; 82 (6): 1389—1395.

Ing R.D., Nazeeri M.N., Zeldes S. et al.Hypertonic saline/dextran improves septic myocardial performance. Am. Surg. 1994; 60 (7): 505—508.

Smith G. J., Kramer G. C., Perron P. et al.A comparison of several hyper-tonic solutions for resuscitation of bled sheep. J. Surg. Res. 1985; 39 (6): 517—528.

Oliveira S. A., Bueno R. M., Souza J. M. et al.Effects of hypertonic saline dextran on the postoperative evolution of Jehovah’s Witness patients submitted to cardiac surgery with cardiopulmonary bypass. Shock 1995; 3 (6): 391—394.

Jarvela K., Kaukinen S.Hypertonic saline (7.5%) after coronary artery bypass grafting. Eur. J. Anaesthesiol. 2001; 18 (2): 100—107.

Jarvela K., Kaukinen S.Hypertonic saline (7.5%) decreases periopera-tive weight gain following cardiac surgery. J. Cardiothorac. Vasc. Anesth. 2002; 16 (1): 43—46.

Jarvela K., Koskinen M., Kaukinen S., Koobi T.Effects of hypertonic saline (7.5%) on extracellular fluid volumes compared with normal saline (0.9%) and 6% hydroxyethyl starch after aortocoronary bypass graft surgery. J. Cardiothorac. Vasc. Anesth. 2001; 15 (2): 210—215.

Bueno R., Resende A. C., Melo R. et al.Effects of hypertonic saline-dex-tran solution in cardiac valve surgery with cardiopulmonary bypass. Ann. Thorac. Surg. 2004; 77 (2): 604—611.

Bruegger D., Bauer A., Rehm M. et al.Effect of hypertonic saline dextran on acid-base balance in patients undergoing surgery of abdominal aortic aneurysm. Crit. Care Med. 2005; 33 (3): 556—563.

Cross J. S., Gruber D. P., Burchard K. W. et al.Hypertonic saline fluid therapy following surgery: a prospective study. J. Trauma 1989; 29 (6): 817—825.

Shackford S. R., Fortlage D. A., Peters R. M. et al.Serum osmolar and electrolyte changes associated with large infusions of hypertonic sodium lactate for intravascular volume expansion of patients undergoing aortic reconstruction. Surg. Gynecol. Obstet. 1987; 164 (2): 127—136.

Sirieix D., Hongnat J.M., Delayance S. et al.Comparison of the acute hemodynamic effects of hypertonic or colloid infusions immediately after mitral valve repair. Crit. Care Med. 1999; 27 (10): 2159—2165.

Prien T., Thulig B., Wusten R. et al.Hyperoncotic-hypertonic volume replacement (7,5% NaCl/10% hydroxyethyl starch 200,000/0,5) in patients with coronary artery stenoses. Zentralbl. Chir. 1993; 118 (5): 257—263.

Croft D., Dion Y. M., Dumont M., Langlois D.Cardiac compliance and effects of hypertonic saline. Can. J. Surg. 1992; 35 (2): 139—144.

Younes R. N., Aun F., Accioly C. Q. et al.Hypertonic solutions in the treatment of hypovolemic shock: a prospective, randomized study in patients admitted to the emergency room. Surgery 1992; 111 (4): 380—385.

Vassar M. J, Perry C. A., Holcroft J. W.Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. J. Trauma 1993; 34 (5): 622—6

Auler J. O. Jr., Pereira M. H., Gomide-Amaral R. V. et al.Hemodynamic effects of hypertonic sodium chloride during surgical treatment of aortic aneurysms. Surgery 1987; 101 (5): 594—601.

Al-Khaja N., Belboul A., Bergman P. et al.Cutaneous microcirculation and blood rheology following cardiopulmonary bypass. Laser Doppler flow-metric and blood cell rheologic studies. Scand. J. Thorac. Cardiovasc. Surg. 1988; 22 (2): 149—153.

Utley J. R., Stephens D. B.Fluid balance during cardiopulmonary bypass. In: Utley J. R. (ed.). Pathophysiology and technique of car-diopulmonary bypass. Baltimore: Williams&Wilkins; 1982. 23—

Бабаев М. А., Еременко А. А., Винницкий Л. И., Бунятян К. А.Причины возникновения полиорганной недостаточности при кардио-хирургических операциях в условиях искусственного кровообращения. Общая реаниматология 2010; VI (3): 76—81.

Mazzoni M. C., Borgstrom P., Intaglietta M., Arfors K. E.Capillary narrowing in hemorrhagic shock is rectified by hyperosmotic saline — dex-tran reinfusion. Circ. Shock 1990; 31 (4): 407—418.

Mazhar R., Samenesco A., Royston D., Rees A.Cardiopulmonary effects of 7,2% saline solution compared with gelatin infusion in the early postoperative period after coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 1998; 115 (1): 178—189.

Kvalheim V. L., Rynning S. E., Farstad M. et al.Fluid overload during cardiopulmonary bypass is effectively reduced by a continuous infusion of hypertonic saline/dextran (HSD). Scand. Cardiovasc. J. 2008; 42 (1): 63—70.

Cecchetti C., Stoppa F., Vanacore N. et al.Monitoring of intrathoracicv-olemia and cardiac output in critically ill children. Minerva Anestesiol. 2003; 69 (12): 907—918.

Kirov M. Y, Kuzkov V. V., Kuklin V. N. et al.Extravascular lung water assessed by transpulmonary single thermodilution and postmortem gravimetry in sheep. Crit. Care 2004; 8 (6): R451—R458.

Schroth M., Plank C., Meissner U. et al.Hypertonic-Hyperoncotic solutions improve cardiac function in children after open-heart surgery. Pediatrics 2006; 118 (1); e76—e84.

Sirvinskas E., Sneider E., Svagzdiene M. et al.Hypertonic hydroxyethyl starch solution for hypovolemia correction following heart surgery. Perfusion 2007; 22 (2): 121 — 127.

Molter G.P., Soltesz S., Larsen R. et al.Hemodynamic effects following preoperative hypervolemichaemodilution with hypertonic hyperoncot-ic colloid solutions in coronary artery bypass graft surgery. Anaesthesist 2003; 52 (10): 905—918.

Molter G. P., Silomon M., Bauer C. et al.Effects of hyperoncotic or hypertonic-hyperoncotic solutions on polymorphonuclear neutrophil count, elastase- and superoxide-anion production: a randomized controlled clinical trial in patients undergoing elective coronary artery bypass grafting. Acta Anaesthesiol. Scand. 2007; 51 (7): 914—921.

Junger W. G., Coimbra R., Liu F. C. et al.Hypertonic saline resuscitation: a tool to modulate immune function in trauma patients? Shock 1997; 8 (4): 235—241.

Coimbra R., Junger W. G., Hoyt D. B. et al.Hypertonic saline resuscitation restores hemorrhage-induced immunosuppression by decreasing prostaglandin E2 and interleukin-4 production. J. Surg. Res 1996; 64 (2): 203-209.

Kolsen-Petersen J. A., Nielsen J. O., Bendtzen K., Tonnesen E.Infusion of hypertonic saline (7.5% NaCl) causes minor immunological changes in normovolaemic women. Acta Anaesthesiol. Scand. 2004; 48 (2): 224—233.

Pascual J. L., Khwaja K. A., Ferri L. E. et al.Hypertonic saline resuscitation attenuates neutrophil lung sequestration and transmigration by diminishing leukocyteendothelial interactions in a two-hit model of hemorrhagic shock and infection. J. Trauma 2003; 54 (1): 121—130.

Rizoli S. B., Kapus A., Parodo J., Rotstein O. D.Hypertonicity prevents lipopolysaccharide-stimulated CD11b/CD18 expression in human neu-trophils in vitro: role for p38 inhibition. J. Trauma 1999; 46 (5): 794—798.

Cuschieri J., Gourlay D., Garcia I. et al.Hypertonic preconditioning inhibits macrophage responsiveness to endotoxin. J. Immunol. 2002; 168 (3): 1389—1396.

Badiwala M. V., Ramzy D., Tumiati L. C. et al.Donor pretreatment with hypertonic saline attenuates primary allograft dysfunction: a pilot study in a porcine model. Circulation 2009; 120 (11 Suppl): S206—S214.

Lillehei C. W.Historical development of cardiopulmonary bypass. In: Gravlee G. P., Davis R. F., Utley J. R. Cardiopulmonary bypass: prinic-ples and practice. Baltimore: Williams & Wilkins; 1993.

Llinas R., Barbut D., Caplan L. R.Neurologic complications of cardiac surgery. Prog. Cardiovasc. Dis. 2000; 43 (2): 101—112.

Murkin J. M., Martzke J. S., Buchan A. M. et al.A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. II. Neurological and cognitive outcomes. J. Thorac. Cardiovasc. Surg. 1995; 110 (2): 349—362.

Vassar M.J., Fischer R. P., O Brien P. E. et al.A multicenter trial for resuscitation of injured patients with 7,5% sodium chloride. The effect of added dextran 70.The multicenter Group for the study of hypertonic saline in trauma patients. Arch. Surg. 1993; 128 (9): 1003—1011.

Wade C. E., Grady J. J., Kramer G. C. et al.Individual patient cohort analysis of the efficacy of hypertonic saline/dextran in patients with traumatic brain injury and hypotension. J. Trauma 1997; 42 (5 Suppl): S61—S65.

McDaniel L. B., Nguyen T., Zwischenberger J. B. et al.Hypertonic saline dextran prime reduces increased intracranial pressure during car-diopulmonary bypass in pigs. Anesth. Analg. 1994; 78 (3): 435—441.

Kaakinen T., Alaoja H., Heikkinen J. et al.Hypertonic saline dextran improves outcome after hypothermic circulatory arrest: a study in a surviving porcine model. Ann. Thorac. Surg. 2006; 81 (1): 183—190.

The authors declare that there are no conflicts of interest present.