Increased plasma viscosity prolongs microhemodynamic conditions during small volume resuscitation from hemorrhagic shock
Increased plasma viscosity prolongs microhemodynamic conditions during small volume resuscitation from hemorrhagic shock
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DOI：
10.1016/j.resuscitation.2008.01.008
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发表时间：
2008-06-01
期刊：
影响因子：
6.5
通讯作者：
Intaglietta, Marcos
中科院分区：
文献类型：
--
作者：
Cabrales, Pedro;Tsai, Amy G.;Intaglietta, Marcos
在金黄地鼠窗室模型上研究了高渗盐水（HTS，7.5%NaCl）和小容量血浆扩张剂复苏失血性休克时的全身和微血管血流动力学反应，以确定血浆扩张剂粘度在急性复苏结局中的作用。采用动脉控制性出血50%血容量（BV）诱导中度失血性休克，维持低血容量状态1h。通过输注HTS、3.5%BV和10%BV血浆扩张剂进行容量恢复。根据HTS后输注的血浆膨胀剂命名实验组，即：[Hextend]、Hextend（R）（6%羟乙基淀粉670 kDa乳酸盐电解质溶液，4 cp）、[Hextend+V]、Hextend（R），通过添加0.4%藻酸盐增加粘度，8 cp，和[NVR]无容量复苏作为对照组。在失血、休克和复苏过程中测定全身参数、微血管血流动力学和毛细血管灌注。Hextend + V组平均动脉压（MAP）最高，其次为Hextend+V组和NVR组。增加血浆粘度并不增加外周血管阻力。Hextend+V的功能性毛细血管密度（FCD）高于Hextend和NVR。酸碱平衡的恢复水平与微血管灌注相关，与Hextend和NVR相比，Hextend+V的恢复水平显着改善。这些结果表明，在失血性休克的小容量复苏过程中，通过提高血浆粘度来恢复血液流变学特性，影响微血管灌注的重建是重要的。(C)2008爱思唯尔爱尔兰有限公司保留所有权利。
Systemic and microvascular hemodynamic responses to hemorrhagic shock resuscitation with hypertonic saline (HTS, 7.5% NaCl) followed with a small volume of plasma expander were studied in the hamster window chamber model to determine the rote of plasma expander viscosity in the acute resuscitation outcome. Moderate hemorrhagic shock was induced by arterial controlled bleeding of 50% of blood volume (BV) and the hypovolemic state was maintained for 1 h. Volume restitution was performed by infusion of HTS, 3.5% of BV followed by 10% of BV plasma expanders. Resuscitation was followed for 90 min. The experimental groups were named based on the plasma expanders infused after the HTS, namely: [Hextend], Hextend(R) (6% Hetastarch 670 kDa in lactated electrolyte solution, 4 cp), [Hextend+V], Hextend(R) with viscosity enhanced by the addition of 0.4% alginate, 8 cp, and [NVR] no volume resuscitation as control group. Measurement of systemic parameters, microvascular hemodynamics and capillary perfusion were performed during hemorrhage, shock and resuscitation. Restitution with Hextend yielded the higher mean arterial pressure (MAP), followed by Hextend+V and NVR. Increasing plasma viscosity did not increase peripheral vascular resistance. Functional capillary density (FCD) was higher for Hextend+V than Hextend and NVR. The level of restoration of acid-base balance correlated with microvascular perfusion and was significantly improved with Hextend+V when compared to Hextend and NVR. These results suggest the importance of restoration of blood rheological properties through enhancing plasma viscosity, influencing the re-establishment of microvascular perfusion during small volume resuscitation from hemorrhagic shock. (C) 2008 Elsevier Ireland Ltd. All rights reserved.