Low-volume resuscitation using polyethylene glycol-20k in a preclinical porcine model of hemorrhagic shock.
Low-volume resuscitation using polyethylene glycol-20k in a preclinical porcine model of hemorrhagic shock.
复制标题
DOI：
10.1097/ta.0000000000001155
复制
发表时间：
2016-12
期刊：
影响因子：
--
通讯作者：
Mangino MJ
中科院分区：
文献类型：
--
作者：
Plant V;Limkemann A;Liebrecht L;Blocher C;Ferrada P;Aboutanos M;Mangino MJ
聚乙二醇-20k (PEG-20k) 通过增加对低容量状态的耐受性，对于低容量复苏 (LVR) 非常有效。在我们的啮齿动物休克模型中，与盐水相比，PEG-20k 提高了存活率并将“黄金时间”延长了 16 倍。分子机制很大程度上归因于低流量缺血后细胞和组织液转移的正常化，导致有效的微血管交换。本研究的目的是评估 PEG-20k 作为临床前模型中失血性休克的低容量复苏溶液。麻醉的雄性约克夏猪（30-40 kg）失血至 MAP 35-40 mmHg。一旦乳酸达到 7 mM/L，就以 10% 计算血容量快速输注盐水 (n = 5) 或 10% PEG-20k (n = 5)。主要结局是 LVR 时间，定义为从 LVR 给药到乳酸再次达到 7 mM/L 的时间。其他测量的结果包括：MAP、心率 (HR)、心输出量 (CO)、混合静脉氧饱和度 (SvO2)、内脏血流量和血红蛋白。相对于生理盐水，控制出血后给予 PEG-20k 可使 LVR 时间延长 16 倍，这是保守估计，因为 PEG-20k 组 LVR 后乳酸从未升高。 PEG-20k LVR 的存活率为 80%，而盐水对照的存活率为 0%（P<0.05）。 PEG-20k 还显着降低出血后的 HR，并增加 CO、MAP、内脏流量和 SvO2。血红蛋白浓度下降表明液体转移到血管内室造成了相当大的血液稀释。在受控失血性休克的临床前模型中，与生理盐水相比，基于 PEG-20k 的 LVR 溶液对休克状态的耐受性提高了 16 倍。 PEG-20k 是一种用于低容量复苏的优质晶体，可以增加院前环境中的安全运输时间，并可用于医院急诊室和手术室，用于等待容量补充或细胞、组织和室液体容量正常化的患者。
Polyethylene glycol-20k (PEG-20k) is highly effective for low volume resuscitation (LVR) by increasing tolerance to the low volume state. In our rodent shock model, PEG-20k increased survival and expanded the “golden hour” 16-fold compared to saline. The molecular mechanism is largely attributed to normalizations in cell and tissue fluid shifts after low flow ischemia resulting in efficient microvascular exchange. The objective of this study was to evaluate PEG-20k as a low volume resuscitation solution for hemorrhagic shock in a pre-clinical model. Anesthetized male Yorkshire pigs (30–40 kg) were hemorrhaged to a MAP of 35–40 mmHg. Once lactate reached 7 mM/L, either saline (n = 5) or 10% PEG-20k (n = 5) was rapidly infused at 10% calculated blood volume. The primary outcome was LVR time, defined by the time from LVR administration to the time when lactate again reached 7 mM/L. Other outcomes measured included: MAP, heart rate (HR), cardiac output (CO), mixed venous oxygen saturation (SvO2), splanchnic blood flow, and hemoglobin. Relative to saline, PEG-20k given after controlled hemorrhage increased LVR time by 16-fold, a conservative estimate given that the lactate never rose after LVR in the PEG-20k group. Survival was 80% for PEG-20k LVR compared to 0% for the saline controls (P<0.05). PEG-20k also significantly decreased HR after hemorrhage and increased CO, MAP, splanchnic flow, and SvO2. Falling hemoglobin concentrations suggested sizable hemodilution from fluid shifts into the intravascular compartment. In a pre-clinical model of controlled hemorrhagic shock, PEG-20k-based LVR solution increased tolerance to the shock state 16-fold compared to saline. PEG-20k is a superior crystalloid for low volume resuscitation that may increase safe transport times in the prehospital setting and find use in hospital emergency departments and operating rooms for patients awaiting volume replacement or normalization of cell, tissue, and compartment fluid volumes.