EFFECTS OF BLOOD TRANSFUSION IN EQUAL AMOUNTS AND MASSIVE INFUSIONS UPON THE CIRCULATION AND SODIUM SPACE IN MASSIVE HEMORRHAGE

Experimental studies on blood transfusion and massive infusion of plasma expander (dextran) and physiological saline solution were made in dogs whose blood was withdrawn through the femoral artery, maintaining the blood pressure at the level of 50mmHg systolic. Despite the individual ability of compensation to the bleeding in the bottle, two stages were recognized, i. e., bleeding and backflow stages. The autotransfusion and infusions of dextran by 100cc/kg and physiological saline solution were performed in both stages; their effects upon circulation, sondium space and urinary excretion were observed. 1) The infused dextran showed less extravasation and more plasma expanding effects not only in the bleeding stage, which had a sufficient compensatory ability, but in the backflow stage which already showed decompensation, compared to the physiological saline solution. It remained in the blood stream even in the terminal stage of bleeding shock or irreversible stage. 2) The infusion of dextran and physiological saline solution caused the sodium space to increase as the infusion increased and to decrease as the urinary excretion decreased in the bleeding stage. They increased more than the amount infused in the backflow stage because of the increased permeability of erythrocytes. In the latter stage, the sodium space was larger in the transfusion of physiological saline solution than in that of dextran since the permeability of erythrocytes to Na was higher than that of dextran. 3) The infusion of physiological saline solution showed more urinary excretion in either stage and maintained the selective excretion of electrolytes and high molecular fluids even in the backflow stage. 4) The dextran showed more excretion of Na24 and the increasing trend of u/p ratio (urine counts/plasma counts) than the physiological saline solution even in the backflow stage, that is, the dextran proved to be more effective than the physiological saline solution in regard to the urinary excretion. 5) Though the experimental transfusion in the backflow stage resulted in death within 24 hours, the group of dextran survived longer than that of physiological saline solution.