Choice of fluid influences outcome in prolonged hypotensive resuscitation after hemorrhage in awake rats
Choice of fluid influences outcome in prolonged hypotensive resuscitation after hemorrhage in awake rats
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DOI：
10.1097/01.shk.0000156667.04628.1f
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发表时间：
2005-04-01
期刊：
影响因子：
3.1
通讯作者：
Atkins, JL
中科院分区：
文献类型：
--
作者：
Handrigan, MT;Bentley, TB;Atkins, JL
低血压复苏 (Hypo) 被认为是临床环境中的一种替代复苏策略，无法应用标准的高级创伤生命支持护理。然而，这种方法在长时间使用时的有效性仍有待证明。本研究的目的是评估延长 Hypo 作为使用各种当前可用的复苏液进行标准复苏的替代方案。未麻醉的雄性斯普拉格-道利大鼠接受计算机控制的失血性休克和复苏。有六个实验组；非出血 (NH)、非复苏对照 (C)、海波与乳酸林格氏液 (Hypol-R)、海波与 Hextend (R)、6% 羟乙基淀粉平衡盐溶液 (HEX)、海波与 PolyHeme (R)、聚合血红蛋白溶液 (HBOC) 或标准复苏与 LR (StandLR)。将动物放血超过 15 分钟，平均动脉血压 (MAP) 为 40 mmHg，其中血压 (BP) 保持 30 分钟。低血压组复苏至 60 mmHg 4 小时，然后进一步复苏至 80 mmHg。 StandLR大鼠在出血期后立即复苏至80mmHg。监测动物直至死亡或在24小时处死。与 C 相比，HEX 或 LR 的延长 Hypo 具有改善 24 小时生存率的趋势（分别为 71%、65% 和 48%），并且表现至少与 StandLR 一样好（58% 生存率）。与 HypoLR (1.9 x EBV) 和 StandLR (3.2 x EBV) 相比，HEX 所需的静脉输液量显着减少 (0.7 x 总估计血容量 [EBV]) (P < 0.05)。尽管 HBOC 需要的液体量最少 (0.4 x EBV)，但生存率并不比 C 好，并且会导致最严重的酸中毒。这些结果支持了使用 Heextend for Hypo 的决定，该策略目前正在战场上应用。
Hypotensive resuscitation (Hypo) has been considered an alternate resuscitation strategy in clinical settings that prevent the application of standard Advanced Trauma Life Support care. However, validation of this approach when used for prolonged periods of time remains to be demonstrated. The purpose of this study was to evaluate prolonged Hypo as an alternative to standard resuscitation using various currently available resuscitative fluids. Unanesthetized, male Sprague-Dawley rats underwent computer-controlled hemorrhagic shock and resuscitation. There were six experimental groups; nonhemorrhage (NH), nonresuscitated control (C), Hypo with lactated Ringer's (Hypol-R), Hypo with Hextend (R), 6% hydroxyethyl starch in a balanced salt solution (HEX), Hypo with PolyHeme (R), a polymerized hemoglobin solution (HBOC), or standard resuscitation with LR (StandLR). Animals were bled over 15 min to a mean arterial blood pressure (MAP) of 40 mmHg where the blood pressure (BP) was held for 30 min. Hypo groups were resuscitated to 60 mmHg for 4 h followed by further resuscitation to 80 mmHg. StandLR rats were resuscitated to 80 mmHg immediately after the hemorrhage period. Animals were monitored until death or they were sacrifice at 24 h. Prolonged Hypo with HEX or LR resulted in a trend toward improved 24-h survival compared with C (71%, 65%, and 48%, respectively), and performed at least as well as StandLR (58% survival). HEX required significantly less intravenous fluid (0.7 x total estimated blood volume [EBV]) compared with HypoLR (1.9 x EBV) and StandLR (3.2 x EBV) (P < 0.05). Although HBOC required the smallest fluid volume (0.4 x EBV), survival was no better than C and it resulted in the most significant acidosis. These results support the decision to use Hextend for Hypo, a strategy currently being applied on the battlefield.