R. EDDY RAHARDJO, - (1995) PERAN NaCI 5% - DEKSTRAN 70-6% - 10% DALAM MEMPERTAHANKAN HEMODINAMIKA PADA PERDARAHAN AKUT. Disertasi thesis, UNIVERSITAS AIRLANGGA.

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Abstract

This study investigates hypertonic NaCl in combination with Dextran-70 as an alternative to Ringer Lactate (RL) to replace blood loss in acute hemorrhage. METHOD 59 preoperative consented patients meeting inclusion criteria underwent blood donation procedure up to approximately 25% of Estimated Blood Volume under strict continuous hemodinamic monitoring utilizing direct arterial pressure measurement. Blood collected were replaced by randomly assigned CPTD-I (or Cl) 20 cases, CPTD-II (or C2) 20 cases and RL 19 cases. CPTD-I is combination of 5 % NaCl and 6 % Dextran-70 while CPTD-II is 5% NaCl and 10% Dextran-70. The research variables included intra-arterial pressure, heart rate, capillary Sp02, arterial blood gases, hemoglobin, hematocrit, lactate, serum albumin, Sodium and Potassium. Measurements were taken before and after blood tapping and HYPOTHESIS after fluid replacement. CPTD-I and CPTD-II support hemodynamic better than Ringer Lactate in acute blood loss. RESULTS : 1. Cl and C2 restored arterial pressure above baseline values in 5-10 minutes time, much faster than RL. At 5 minutes after start of replacement systolic pressure among C1 and C2 were significantly higher than RL. This prompt overshoot of baseline values may benefit flushing sluggish microcirculation. Anova test of the Area-under-curve (AUC) showed significant difference among groups (p= 0.028). Further t-test showed the difference between C2 and RL ( p= 0. 008). Mean Arterial Pressure differed between CPTD and RL in R+5 (p=0.0002) and R+lO minutes (p=0.026). MAP of Cl/C2 persisted high above baseline values while RL reached only the baseline. Pulse Pressure showed early stabilization in the Cl/C2 groups. C2 values were consistenly higher than C1 values as well as its own baseline values. The differences between C2 and RL persisted until end of this investigation (R+30), p = 0.047. AUC analyses showed significant difference between C2 and RL (p=0.004). Equal volume hemodilution were achieved as supported by the decrease of hemoglobins, hematocrits and albumin levels. 2. Cl and C2 preserved tissue oxygenation as shown by normal Arterial oxygen tensions (p02) and capillary saturations (Sp02). Arterial lactate increased only in RL group. 3. C1 and C2 did not induce (dangerous) hypernatremia. At 5 minutes after the start of infusions showed highest values to be 158 mEq/L in C1 and 157 mEq/L in C2 which returned to normal in 30 minutes. 4. C1 and C2 supported normotensive blood pressure. In 47 % patients underwent anesthetic-induction 2-6 hours afterward, systolic pressure of 113.3 ± 5.8 to 120.0 ± 10.0 were in the range of pre-operative± 10%. CONCLUSIONS : 1. C1 and C2 are better option to RL for the first line treatment of acute hemorrhage to stabilize the blood pressure quickly. One bottle of 250 ml volume is sufficient to replace 1000 ml hemorrhage in one adult. 2. C1 and C2 subti tute blood transfusion which prevent transmissions of hepatitis and HIV/AIDS.

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