Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000500006
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos hemodinâmicos e metabólicos imediatos determinados pelas soluções de cloreto de sódio a 7,5% e de sua associação ao dextran 70 a 6% na reanimação do choque hemorrágico: estudo experimental em cães

Immediate hemodynamic and metabolic effects of 7.5% sodium chloride and its association with 6% dextran 70 in hemorragic shock resuscitation: an experimental study in dogs

José Fernando Amaral Meletti; José Reinaldo Cerqueira Braz; Norma Sueli Pinheiro Módolo

http://dx.doi.org/10.1590/S0034-70942006000500006 Braz J Anesthesiol, vol.56, n5, p.478-494, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: O dextran associado à solução hipertônica de cloreto sódio a 7,5% apresenta efeitos hemodinâmicos benéficos no controle prolongado da reanimação no choque hemorrágico. O objetivo deste estudo foi verificar se a associação do dextran à solução de cloreto de sódio a 7,5% apresentaria vantagens na avaliação imediata dos parâmetros hemodinâmicos e metabólicos na reanimação em modelo de choque hemorrágico controlado em cães. MÉTODO: Foram estudados 16 cães submetidos à hemorragia controlada até que a pressão arterial média atingisse 40 mmHg e permanecesse assim por até 30 minutos. Estes foram divididos em G1, com administração de NaCI a 7,5%, e G2, com administração NaCI a 7,5% combinada com dextran 70 a 6%, no volume de 4 mL.kg-1, durante três minutos. Foram avaliados os parâmetros hemodinâmicos e metabólicos. Consideraram-se quatro momentos: M1 - 10 minutos após o preparo cirúrgico, M2 - obtido na metade da fase de choque, M3 - obtido dois minutos após o final da administração das soluções, M4 - 30 minutos após o início da reanimação. RESULTADOS: Após a reanimação, não houve diferença significativa dos valores da FC, PAM, PCP e IRVS. O G2 apresentou valores maiores do IC em M4. Os valores da SvO2 foram menores no G1, final do experimento. A C(a-v)O2 foi maior no G1 nos momentos M3 e M4. Os valores do VO2 aumentaram nos dois grupos em M4 e os valores do lactato plasmático aumentaram progressivamente até M3 e diminuíram em M4. Houve aumento dos valores do Na plasmático e redução do hematócrito nos dois grupos. CONCLUSÕES: O G2 mostrou melhor desempenho hemodinâmico principalmente após 30 minutos do início da reanimação. Observou-se, também, maior expansão plasmática e melhor perfusão tecidual na associação do dextran ao NaCl a 7,5%.

Palavras-chave

ANIMAIS, CHOQUE, VOLEMIA

Abstract

BACKGROUND AND OBJECTIVES: Dextran associated with 7.5% sodium chloride has positive hemodynamic effects in the long term control of hemorrhagic shock. The objective of this study was to verify whether the association of dextran with 7.5% chloride solution would be advantageous in the immediate hemodynamic evaluation of controlled hemorrhagic shock in dogs. METHODS: This study included 16 dogs submitted to controlled hemorrhage until their mean arterial blood pressure reached 40 mmHg, being maintained at this level for 30 minutes. They were divided in two groups: G1 received 7.5% NaCl and G2 received 7.5% NaCl in 6% dextran 70; in both groups, 4 mL.kg-1 of the solutions were administered for three minutes. Hemodynamic and metabolic parameters were evaluated in four different phases: M1 - 10 minutes after preparation for surgery, M2 - obtained in the middle of the shock phase. M3 - two minutes after the administration of the IV solutions, M4 - 30 minutes after the beginning of the resuscitation. RESULTS: After the resuscitation, there were no significant differences in HR, MAP, PCP, and SVRI. G2 presented the highest CI values in M4. G1 showed the smaller SvO2 values at the end of the experiment; and the C(a-v)O2 was higher in M3 and M4. For both groups, VO2 values increased in M4, and lactate plasma values increased progressively until M3, decreasing in M4. Both groups also presented increased Na plasma values and decreased hematocrit. CONCLUSIONS: G2 showed the best hemodynamic performance, especially 30 minutes after the beginning of resuscitation. Plasma expansion and tissue perfusion were also better with 7.5% NaCl in dextran.

Keywords

ANIMALS, SHOCK, VOLEMIA

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