Ringer's ethyl pyruvate in hemorrhagic shock and resuscitation does not improve early hemodynamics or tissue energetics
Ringer's ethyl pyruvate in hemorrhagic shock and resuscitation does not improve early hemodynamics or tissue energetics
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DOI：
10.1097/01.shk.0000153353.58341.ff
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发表时间：
2005-03-01
期刊：
影响因子：
3.1
通讯作者：
Hammer, BE
中科院分区：
文献类型：
--
作者：
Mulier, KE;Beilman, GJ;Hammer, BE
活性氧（ROS）参与了失血性休克的发病机制。丙酮酸乙酯是丙酮酸的衍生物，被认为是一种氧自由基清除剂，是一种很有吸引力的复苏液。我们研究了含丙酮酸乙酯（REP）的乳酸林格氏液（LR）复苏与单纯LR相比，对失血性休克是否有任何血流动力学或组织能量方面的益处。在脾切除的猪中通过下腔静脉插管诱导失血性休克。休克90分钟后，以20 cc/kg/步的LR或REP（30 mg/kg/剂，在LR中以1.5 mg/mL给药）以逐步方式复苏动物，共4步。实验期间收集的数据包括生理和血液动力学参数，胃、肝和后肢组织血红蛋白氧（StO（2））的近红外反射光谱测量，以及每个时间点肝和后肢的核磁共振磷谱。在两个复苏组中，心率、乳酸和丙酮酸值在休克期间增加，并在复苏期间开始向基线值下降。平均动脉压、氧输送和氧消耗在休克期间降低，在复苏过程中向基线水平增加。LR-和REP-复苏动物之间的生理参数无显著变化。在REP复苏动物的后期复苏终点，胃StO（2）和后肢细胞胞质pH值显著降低。这些发现的临床意义尚不清楚。与LR相比，使用REP作为复苏液没有短期血流动力学或组织能量优势。需要进行长期结局研究，以进一步评估在失血性休克中使用REP的任何潜在益处。
Reactive oxygen species (ROS) have been implicated in the pathogenesis of hemorrhagic shock. Ethyl pyruvate, a derivative of pyruvate and a proposed oxygen radical scavenger, is attractive as a possible resuscitation fluid. We investigated whether resuscitation with lactated Ringer's (LR) containing ethyl pyruvate (REP) had any hemodynamic or tissue energetic benefits compared with LR alone for hemorrhagic shock. Hemorrhagic shock was induced in splenectomized pigs via inferior vena cava cannula. After 90 min of shock, animals were resuscitated in a stepwise fashion with LR or REP (30 mg/kg/dose, given as 1.5 mg/mL in LR) at 20 cc/kg/step for four steps. Data collected during this experiment included physiologic and hemodynamic parameters, near-infrared reflectance spectroscopy measurements of tissue hemoglobin oxygen (StO(2)) of the stomach, liver, and hind limb, and nuclear magnetic resonance phosphorus spectra of the liver and hind limb at each time point. In both resuscitative groups, heart rate, and lactate and pyruvate values increased during shock and began to drop toward baseline values during resuscitation. Mean arterial pressure, oxygen delivery, and oxygen consumption decreased during shock and increased toward baseline levels during the resuscitative process. There were no significant changes in physiologic parameters between the LR- and REP-resuscitated animals. There was a significantly lower stomach StO(2) and hind limb cellular cytoplasmic pH during later resuscitative endpoints in REP-resuscitated animals. The clinical significance of these findings are unclear. There is no short-term hemodynamic or tissue energetic advantage to using REP as a resuscitation fluid when compared with LR. Long-term outcome studies are needed to further evaluate any potential benefits of use of REP in hemorrhagic shock.