Multifaceted Benefit of Whole Blood Versus Lactated Ringer's Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice.
Multifaceted Benefit of Whole Blood Versus Lactated Ringer's Resuscitation After Traumatic Brain Injury and Hemorrhagic Shock in Mice.
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小鼠创伤性脑损伤和出血性休克后全血与乳酸林格氏复苏的多方面益处。
DOI：
10.1007/s12028-020-01084-1
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发表时间：
2021-06
影响因子：
3.5
通讯作者：
Jha RM
中科院分区：
文献类型：
--
作者：
Zusman BE;Kochanek PM;Bailey ZS;Leung LY;Vagni VA;Okonkwo DO;Puccio AM;Shutter LA;Janesko-Feldman KL;Gilsdorf JS;Shear DA;Jha RM
尽管在出血性休克（HS）中的使用越来越多，但对于多发性创伤伴创伤性脑损伤（TBI）的全血（WB）复苏在很大程度上尚未探索。目前的TBI指南推荐晶体用于院前复苏。虽然WB在TBI + HS模型中增加平均动脉压（MAP）方面优于乳酸林格氏（LR），但对脑组织氧合（PbtO 2）和最佳MAP的影响仍不明确。C57 BL/6小鼠（n = 72）进行受控皮质撞击，然后进行HS（MAP = 25-27 mmHg）。采用微电极法测定同侧海马PbtO 2（n = 40）。将小鼠分配到四个组（n = 18/组）中，用LR或自体WB进行“院前”复苏（90分钟），目标MAP为60或70 mmHg（LR 60、WB 60、LR 70、WB 70）。对于低于目标的MAP，每5分钟推注额外的LR（10 ml/kg）。WB 60（7.2 ± 5.0 mL/kg）和WB 70（28.3 ± 9.6 mL/kg）的LR需求显著低于LR 60（132.8 ± 5.8 mL/kg）或LR 70（152.2 ± 4.8 mL/kg;所有p < 0.001）。WB 70组平均动脉压（72.5 ± 2.9 mmHg）高于LR 70组（59.8 ± 4.0 mmHg，p < 0.001）。WB 60组平均动脉压（68.7 ± 4.6 mmHg）高于LR 60组（53.5 ± 3.2 mmHg，p < 0.001）。WB 60组的PbtO 2（43.8 ± 11.6 mmHg）高于LR 60组（25.9 ± 13.0 mmHg，p = 0.04）或LR 70组（24.1 ± 8.1 mmHg，p = 0.001）。WB 70的PbtO 2（40.7 ± 8.8 mmHg）高于LR 70（p = 0.007）。尽管WB 70组的MAP高于WB 60组（p = .002），但PbtO 2相似。与标准LR复苏相比，TBI + HS后WB复苏可显著改善脑氧合，同时最大限度地减少液体体积。与LR复苏相比，WB复苏可允许较低的院前MAP而不损害脑氧合。需要进一步研究评估这些生理益处对HS TBI后结局的影响，以最终为临床试验提供信息。
Despite increasing use in hemorrhagic shock (HS), whole blood (WB) resuscitation for polytrauma with traumatic brain injury (TBI) is largely unexplored. Current TBI guidelines recommend crystalloid for prehospital resuscitation. Although WB outperforms lactated Ringer’s (LR) in increasing mean arterial pressure (MAP) in TBI + HS models, effects on brain tissue oxygenation (PbtO2), and optimal MAP remain undefined. C57BL/6 mice (n = 72) underwent controlled cortical impact followed by HS (MAP = 25–27 mmHg). Ipsilateral hippocampal PbtO2 (n = 40) was measured by microelectrode. Mice were assigned to four groups (n = 18/group) for “prehospital” resuscitation (90 min) with LR or autologous WB, and target MAPs of 60 or 70 mmHg (LR60, WB60, LR70, WB70). Additional LR (10 ml/kg) was bolused every 5 min for MAP below target. LR requirements in WB60 (7.2 ± 5.0 mL/kg) and WB70 (28.3 ± 9.6 mL/kg) were markedly lower than in LR60 (132.8 ± 5.8 mL/kg) or LR70 (152.2 ± 4.8 mL/kg; all p < 0.001). WB70 MAP (72.5 ± 2.9 mmHg) was higher than LR70 (59.8 ± 4.0 mmHg, p < 0.001). WB60 MAP (68.7 ± 4.6 mmHg) was higher than LR60 (53.5 ± 3.2 mmHg, p < 0.001). PbtO2 was higher in WB60 (43.8 ± 11.6 mmHg) vs either LR60 (25.9 ± 13.0 mmHg, p = 0.04) or LR70 (24.1 ± 8.1 mmHg, p = 0.001). PbtO2 in WB70 (40.7 ± 8.8 mmHg) was higher than in LR70 (p = 0.007). Despite higher MAP in WB70 vs WB60 (p = .002), PbtO2 was similar. WB resuscitation after TBI + HS results in robust improvements in brain oxygenation while minimizing fluid volume when compared to standard LR resuscitation. WB resuscitation may allow for a lower prehospital MAP without compromising brain oxygenation when compared to LR resuscitation. Further studies evaluating the effects of these physiologic benefits on outcome after TBI with HS are warranted, to eventually inform clinical trials.
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影响因子：
4.2
作者：
Dennis, Alia Marie;Haselkorn, M. Lee;Kochanek, Patrick M.
通讯作者：
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影响因子：
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通讯作者：
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