RESUMO
BACKGROUND: Fluid resuscitation administered before hemorrhage control for trauma victims sustaining penetrating abdominal injury is controversial. Our objective was to evaluate intra-abdominal blood loss and hemodynamic and metabolic effects of no fluid resuscitation, small-volume 7.5% sodium chloride/6% dextran-70 (HSD), or large-volume lactated Ringer's (LR) solution during intra-abdominal vascular injury and uncontrolled hemorrhage. METHODS: In pentobarbital-anesthetized dogs (n = 26, 17 +/- 0.3 kg), a suture was placed through the common iliac artery to produce a 3-mm tear when the exteriorized suture lines were pulled after incision closure. Dogs were randomized to three groups, according to the treatment used after 20 minutes of uncontrolled hemorrhage: controls, no fluid resuscitation (CT group) (n = 6); the HSD group (4 mL/kg over 4 minutes, n = 6); and the LR group (32 mL/kg over 15 minutes, n = 6). After 40 minutes of uncontrolled bleeding, animals were killed, and intra-abdominal blood loss was measured. RESULTS: Eight dogs died from severe hemorrhagic shock before randomization and were excluded. After 20 minutes, animals presented lower blood pressure (approximately 35 mm Hg), low cardiac output (approximately 1.0 L/min/m(2)), and metabolic acidosis (pH approximately 7.23, base excess approximately -9 mmol/L). After HSD and LR solution, arterial pressure presented a transient increase, but remained below baseline. Two animals died before the end of the experiment, both in the LR group. Cardiac index was partially improved in the LR and HSD groups, whereas the CT group sustained a low-flow state. There were no significant differences between groups regarding intra-abdominal blood loss (CT group, 47.8 +/- 5.9 mL/kg; HSD group, 41.7 +/- 2.3 mL/kg; and LR group, 49.4 +/- 0.7 mL/kg). CONCLUSION: Fluid resuscitation with either large-volume LR solution or small-volume HSD, during uncontrolled hemorrhage from intra-abdominal vascular injury, produced hemodynamic and metabolic benefits, without additional blood loss, whereas no fluid resuscitation was associated with sustained low cardiac output and hypotension.
Assuntos
Hidratação/métodos , Hemodinâmica , Hemorragia/terapia , Ressuscitação/métodos , Animais , Cães , Artéria Ilíaca/lesões , MasculinoRESUMO
Determinou-se, em ratos Sprague-Dowley machos e jovens, o efeito de dietas com conteúdo lipídico variável e de tratamento com cimetidina na funçäo da glândula tireóide, durante o período de 70 dias. Avaliando a funçäo tireoideana através de vários parâmetros, determinou-se que estes variam de forma diferente de acordo com a estimativa do nível funcional sob controle do pesquisador, contudo, determinou-se que as dietas ricas em banha e óleo de oliva, além de colesterol e sais biliares, determinam diminuiçäo da capacidade de concentrar iodeto da glândula tireóide, avaliado pela relaçäo T/P, enquanto que a dieta enriquecida em óleo de soja incrementa a relaçäo T/P. O tratamento com cimetidina permite detectar significâncias objetivas apenas no índice de conversäo (PBI/I 131), porque esta aumenta em condiçöes de tratamento com cimetidina, particularmente em condiçöes de dieta rica em banha ou óleo de oliva. Postula-se que a cimetidina poderia interferir a dois níveis diferentes como bloqueador ou antagonista dos receptores H2 da histamina: a nível hipotalâmico (diminuindo a secreçäo de TRH e consequentemente de TSH) e a nível tireoideano (facilitando a secreçäo dos hormônios tireoideanos, talvez por mecanismo H1)