Valproic acid improves survival and decreases resuscitation requirements in a swine model of prolonged damage control resuscitation.
Valproic acid improves survival and decreases resuscitation requirements in a swine model of prolonged damage control resuscitation.
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在长期损害控制复苏的猪模型中，丙戊酸可提高存活率并降低复苏要求。
DOI：
10.1097/ta.0000000000002281
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Alam,HasanB
中科院分区：
文献类型：
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作者：
Williams,AaronM;Bhatti,UmarF;Biesterveld,BenE;Graham,NathanJ;Chtraklin,Kiril;Zhou,Jing;Dennahy,IsabelS;Kathawate,RanganathG;Vercruysse,ClaireA;Russo,RachelM;Li,Yongqing;Alam,HasanB
尽管损害控制复苏（DCR）通常在短时间内进行，但在军事冲突中可能需要延长DCR，作为长期战地护理的一部分。丙戊酸（VPA）已被证明在致死性出血/创伤模型中具有有益特性。方法将15头约克郡猪（40-45 kg）进行致死性（50%估计总血量）出血性休克（HS），并随机分为三组：（1）HS，（2）HS-DCR，（3）HS-DCR-VPA（150 mg/kg，3小时）（n= 5/队列）。在分配接受DCR的组中，应用战术战斗伤亡护理指南（休克期1小时），目标是收缩压80 mm Hg。在72小时时，对存活动物输注浓缩红细胞，模拟后送至更高级别的护理。存活率、生理参数、复苏液体需求和实验室概况用于比较临床结果。DCR将生存率提高到20%，尽管这在统计学上并不显著。在DCR中加入VPA可显著提高存活率至80%（p< 0.01）。VPA治疗的动物也有显着（p< 0.05）较高的收缩压，较低的液体复苏的要求，较高的血红蛋白水平，和较低的肌酐和钾levels.CONCLUSIONVPA管理改善生存，降低复苏的要求，并改善血液动力学和实验室参数时，添加到延长DCR在一个致命的出血模型。
BACKGROUNDAlthough damage control resuscitation (DCR) is routinely performed for short durations, prolonged DCR may be required in military conflicts as a component of prolonged field care. Valproic acid (VPA) has been shown to have beneficial properties in lethal hemorrhage/trauma models. We sought to investigate whether the addition of a single dose of VPA to a 72-hour prolonged DCR protocol would improve clinical outcomes.METHODSFifteen Yorkshire swine (40–45 kg) were subjected to lethal (50% estimated total blood volume) hemorrhagic shock (HS) and randomized to three groups:(1) HS,(2) HS-DCR,(3) HS-DCR-VPA (150 mg/kg over 3 hours)(n= 5/cohort). In groups assigned to receive DCR, Tactical Combat Casualty Care guidelines were applied (1 hour into the shock period), targeting a systolic blood pressure of 80 mm Hg. At 72 hours, surviving animals were given transfusion of packed red blood cells, simulating evacuation to higher echelons of care. Survival rates, physiologic parameters, resuscitative fluid requirements, and laboratory profiles were used to compare the clinical outcomes.RESULTSThis model was 100% lethal in the untreated animals. DCR improved survival to 20%, although this was not statistically significant. The addition of VPA to DCR significantly improved survival to 80%(p< 0.01). The VPA-treated animals also had significantly (p< 0.05) higher systolic blood pressures, lower fluid resuscitation requirements, higher hemoglobin levels, and lower creatinine and potassium levels.CONCLUSIONVPA administration improves survival, decreases resuscitation requirements, and improves hemodynamic and laboratory parameters when added to prolonged DCR in a lethal hemorrhage model.