The impact of early goal-directed fluid management on survival in an experimental model of severe acute pancreatitis
The impact of early goal-directed fluid management on survival in an experimental model of severe acute pancreatitis
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DOI：
10.1007/s00134-012-2775-x
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发表时间：
2013-04-01
影响因子：
38.9
通讯作者：
Reuter, Daniel A.
中科院分区：
文献类型：
--
作者：
Trepte, Constantin J. C.;Bachmann, Kai A.;Reuter, Daniel A.
重症急性胰腺炎（SAP）仍然是一种危及生命的疾病，其典型病因是全身炎症反应，死亡率在30%至50%之间。本研究的目的是比较两种不同的治疗策略的目标导向的血流动力学管理，并评估其对急性胰腺炎的生存，微循环，组织氧合和组织病理学损伤的影响，在前瞻性动物study.34家猪被随机分配到两个不同的治疗组。第1组在诱导急性胰腺炎后，根据中心静脉压（CVP > 12 mmHg）和平均动脉压（MAP）指导容量给药。在第2组中，血流动力学管理主要由左心室每搏量变异度（SVV <10%）、MAP和心输出量（CO）指导。根据随机分组进行治疗6 h，并评价胰腺组织氧分压和胰腺微循环。此后，观察动物7天，然后处死。死后取标准化组织标本，进行组织病理学评分，第2组7天后存活率为29.4%，第1组为11.8%（p < 0.05）。第2组的胰腺氧分压（138.0 +/- A 89.5 mmHg vs 71.1 +/- A 35.3 mmHg; p < 0.05）和胰腺微循环（1，209.9 +/- A 630 Au vs 732 +/- A 315 Au; p < 0.05）显著较高。在第2组中，胰腺内的组织病理学损伤在死后可以被分析为显著更少。在重症急性胰腺炎动物模型中，以每搏输出量变化为指导的目标导向的血流动力学管理导致了生存率、组织氧合和微循环灌注的改善以及更少的组织病理学损伤。
Severe acute pancreatitis (SAP) remains a life-threatening disease with classic etiology of systemic inflammatory response and mortality between 30 and 50 %. The aim of the present study is to compare two different treatment strategies of goal-directed hemodynamic management and evaluate their impact on survival, microcirculation, tissue oxygenation, and histopathologic damage in acute pancreatitis in a prospective animal study.Thirty-four domestic pigs were randomly assigned to two different treatment groups. After induction of acute pancreatitis, in group 1 volume administration was guided by central venous pressure (CVP > 12 mmHg) and mean arterial pressure (MAP). In group 2, hemodynamic management was guided primarily by left-ventricular stroke volume variation (SVV < 10 %), MAP, and cardiac output (CO). Treatment according to randomization was performed for 6 h, and tissue oxygen tension in the pancreas and pancreatic microcirculation were evaluated. Thereafter, animals were observed for 7 days and then sacrificed. Standardized tissue specimens were taken post mortem, and histopathologic scoring was performed.Survival after 7 days was 29.4 % in group 2 versus 11.8 % in group 1 (p < 0.05). Pancreatic oxygen tension (138.0 +/- A 89.5 mmHg versus 71.1 +/- A 35.3 mmHg; p < 0.05) and pancreatic microcirculation (1,209.9 +/- A 630 AU versus 732 +/- A 315 AU; p < 0.05) were significantly higher in group 2. Significantly less histopathologic damage within the pancreas could be analyzed post mortem in group 2.Goal-directed hemodynamic management guided by stroke volume variation led to improved survival, tissue oxygenation, and microcirculatory perfusion, as well as less histopathologic damage in an animal model of severe acute pancreatitis.