Fluid Resuscitation With Isotonic or Hypertonic Saline Solution Avoids Intraneural Calcium Influx After Traumatic Brain Injury Associated With Hemorrhagic Shock

被引:13
作者
Balbino, Marcos [1 ]
Capone Neto, Antonio [1 ]
Prist, Ricardo [1 ]
Ferreira, Alice Teixeira [2 ]
Poli-de-Figueiredo, Luiz F. [1 ]
机构
[1] Univ Sao Paulo, Fac Med, LIM26, Dept Surg, BR-01246903 Sao Paulo, Brazil
[2] Univ Fed Sao Paulo, Dept Byophys, Sao Paulo, Brazil
来源
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 2010年 / 68卷 / 04期
基金
巴西圣保罗研究基金会;
关键词
Calcium metabolism; Hemorrhage; Hypertonic saline; Traumatic brain injury; Shock; INTRACRANIAL-PRESSURE; MULTICENTER TRIAL; LACTATED RINGERS; SODIUM-CHLORIDE; HEAD-INJURY; HYPOTENSION; 7.5-PERCENT; EPIDEMIOLOGY; MANNITOL; DEATHS;
D O I
10.1097/TA.0b013e3181af69d3
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: Calcium is one of the triggers involved in ischemic neuronal death. Because hypotension is a strong predictor of outcome in traumatic brain injury (TBI), we tested the hypothesis that early fluid resuscitation blunts calcium influx in hemorrhagic shock associated to TBI. Methods: Fifteen ketamine-halothane anesthetized mongrel dogs (18.7 kg +/- 1.4 kg) underwent unilateral cryogenic brain injury. Blood was shed in 5 minutes to a target mean arterial pressure of 40 mm Hg to 45 mm Hg and maintained at these levels for 20 minutes (shed blood volume = 26 mL/kg +/- 7 mL/kg). Animals were then randomized into three groups: CT (controls, no fluid resuscitation), HS (7.5% NaCl, 4 mL/kg, in 5 minutes), and LR (lactate Ringer's, 33 mL/kg, in 15 minutes). Twenty minutes later, a craniotomy was performed and cerebral biopsies were obtained next to the lesion ("clinical penumbra") and from the corresponding contralateral side ("lesion's mirror") to determine intracellular calcium by fluorescence signals of Fura-2-loaded cells. Results: Controls remained hypotensive and in a low-flow state, whereas fluid resuscitation improved hemodynamic profile. There was a significant increase in intracellular calcium in the injured hemisphere in CT (1035 nM +/- 782 nM), compared with both HS (457 nM +/- 149 nM, p = 0.028) and LR (392 nM +/- 178 nM, p = 0.017), with no differences between HS and LR (p = 0.38). Intracellular calcium at the contralateral, uninjured hemisphere was 438 nM +/- 192 nM in CT, 510 nM +/- 196 nM in HS, and 311 nM +/- 51 nM in LR, with no significant differences between them. Conclusion: Both small volume hypertonic saline and large volume lactated Ringer's blunts calcium influx in early stages of TBI associated to hemorrhagic shock. No fluid resuscitation strategy promotes calcium influx and further neural damage.
引用
收藏
页码:859 / 864
页数:6
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