Directly Cooling Gut Prevents Mortality in the Rat Model of Reboa Management of Lethal Hemorrhage.
Directly Cooling Gut Prevents Mortality in the Rat Model of Reboa Management of Lethal Hemorrhage.
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DOI：
10.1097/shk.0000000000001744
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发表时间：
2021-11-01
期刊：
影响因子：
--
通讯作者：
Hu B
中科院分区：
文献类型：
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作者：
Liu C;Yuan D;Crawford R;Sarkar R;Hu B
主动脉复苏性血管内球囊阻断术（REBOA）是一种用于救治致命性躯干出血的救命技术。然而，其益处必须与可能导致的致命性远端器官缺血 - 再灌注损伤（IRI）相权衡。本研究采用一种新型的肠道直接降温技术来应对远端器官的IRI。
通过经下腔静脉放血，放出估计总血量的50%，建立大鼠致命性出血模型。将一种新型经直肠结肠内（TRIC）体温管理装置置于降结肠，使结肠内温度维持在37°C或12°C。两组均尽可能将上半身温度维持在37°C左右。经股动脉插入2F Fogarty球囊导管至胸降主动脉，实施REBOA。REBOA后，放气球囊，并回输放出的血液。在REBOA后的180 - 270分钟内继续进行体温管理。
所有在37°C下接受REBOA救治致命性出血的大鼠，均出现严重的肠道和腹部器官组织病理学IRI、严重的功能障碍，且在24小时内全部死亡，死亡率达100%。相比之下，使用新型TRIC装置将结肠直接冷却至10 - 12°C，可消除死亡情况，显著改善动脉血气参数，预防腹部器官损伤，并在REBOA后的7天内减轻功能障碍。
在REBOA救治致命性出血过程中，经直肠直接对结肠降温，可显著改善功能、提供惊人的组织保护，并消除死亡情况。
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving technique for the management of lethal torso hemorrhage. Its benefit, however, must be weighed against the lethal distal organ ischemia-reperfusion injury (IRI). This study uses a novel direct gut cooling technique to manage the distal organ IRI. A rat lethal hemorrhage model was established by bleeding of 50% of the estimated total blood volume via inferior vena cava. A novel TransRectal Intra-Colon (TRIC) temperature management device was positioned in the descending colon either to maintain intra-colon temperature at 37°C or 12°C. The upper body temperature was maintained at as close to 37°C as possible in both groups. A 2F Fogarty balloon catheter was inserted via the femoral artery into the descending thoracic aorta for the implementation of REBOA. After REBOA, the balloon was deflated, and the shed blood was returned. The temperature managements were continued for additional 180–270 min during the post-REBOA period. All rats subjected to REBOA management of lethal hemorrhage at 37°C had severe histopathological gut and abdominal organ IRI, severe functional deficits, and died within 24 h with 100% mortality. By contrast, directly cooling the colon to 10–12°C with the novel TRIC device abolished mortality, and dramatically improved ABG parameters, prevented the abdominal organ injury, and reduced the functional deficits during the 7-day post-REBOA period. Directly trans-rectal colon cooling during REBOA management of lethal hemorrhage offers extraordinary functional improvement and amazing tissue protection, and abolishes mortality.