Does the rate of rewarming from profound hypothermic arrest influence the outcome in a swine model of lethal hemorrhage?
Does the rate of rewarming from profound hypothermic arrest influence the outcome in a swine model of lethal hemorrhage?
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DOI：
10.1097/01.ta.0000198469.95292.ec
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发表时间：
2006-01-01
影响因子：
--
通讯作者：
Chen, Z
中科院分区：
文献类型：
--
作者：
Alam, HB;Rhee, P;Chen, Z
背景快速诱导深低温停搏（假死）可以为复杂损伤的修复提供宝贵的时间，提高生存率。从深度低温状态重新升温的最佳速率是未知的。本实验的目的是测试不同的升温速率对结果的影响，在猪模型的致命出血从复杂的vascular injuries.Methods：不受控制的致命出血诱导40头猪（80-120磅），通过创建髂动脉和静脉损伤，随后30分钟后（模拟运输时间）的胸降主动脉撕裂伤。通过胸廓切开术，将导管置于主动脉中，并在心肺转流术中输注高钾器官保存溶液以快速（2 ℃/min）诱导深度（10 ℃）低温。在低温停搏60分钟期间修复血管损伤。4组（n = 10/组）包括正常体温对照（NC），其中核心温度保持在36至37 ℃之间，并以... 0.25 5摄氏度/分钟（中）或1摄氏度/分钟（快）。在低温停搏期间逆转高钾血症，并在复温期间输注血液进行复苏。停止心肺转流后，动物恢复并监测6周的神经功能缺损、认知功能（学习新技能）和器官功能障碍。结果：所有常温动物死亡，而从低温停搏缓慢、中等和快速复温的存活率分别为50%、90%和30%（p <0.05缓慢和中等复温与常温对照相比，p < 0.05中等与快速复温相比）。所有存活的动物神经系统完整，表现出正常的学习能力，并没有长期的器官dysfunctions.Conclusions：快速诱导低温逮捕维持致命的血管损伤的修复过程中的大脑的活力。长期生存率受体温降低逆转率的影响。
Background. Rapid induction of profound hypothermic arrest (suspended animation) can provide valuable time for the repair of complex injuries and improve survival. The optimal rate for re-warming from a state of profound hypothermia is unknown. This experiment was designed to test the impact of different warming rates on outcome in a swine model of lethal hemorrhage from complex vascular injuries.Methods: Uncontrolled lethal hemorrhage was induced in 40 swine (80-120 lbs) by creating an iliac artery and vein injury, followed 30 minutes later (simulating transport time) by laceration of the descending thoracic aorta. Through a thoracotomy approach, a catheter was placed in the aorta and hyperkalemic organ preservation solution was infused on cardiopulmonary bypass to rapidly (2 degrees C/min) induce profound (10 degrees C) hypothermia. Vascular injuries were repaired during 60 minutes of hypothermic arrest. The 4 groups (n = 10/group) included normothermic controls (NC) where core temperature was maintained between 36 to 37 degrees C, and re-warming from profound hypothermia at rates of. 0.25 degrees C/min (slow), 0.5 degrees C/min (medium), or 1 degrees C/min (fast). Hyperkalemia was reversed during the hypothermic arrest period, and blood was infused for resuscitation during re-warming. After discontinuation of cardiopulmonary bypass, the animals were recovered and monitored for 6 weeks for neurologic deficits, cognitive function (learning new skills), and organ dysfunction. Detailed examination of brains was performed at 6 weeks.Results: All the normothermic animals died, whereas survival rates for slow, medium and fast re-warming from hypothermic arrest were 50, 90, and 30%, respectively (p < 0.05 slow and medium warming versus normothermic control, p < 0.05 medium versus fast re-warming). All the surviving animals were neurologically intact, displayed normal learning capacity, and had no long-term organ dysfunction.Conclusions: Rapid induction of hypothermic arrest maintains viability of brain during repair of lethal vascular injuries. Long-term survival is influenced by the rate of reversal of hypothermia.