Real-Time Metabolic Monitors, Ischemia-Reperfusion, Titration Endpoints, and Ultra-Precise Burn Resuscitation: 37.
Real-Time Metabolic Monitors, Ischemia-Reperfusion, Titration Endpoints, and Ultra-Precise Burn Resuscitation: 37.
复制标题
实时代谢监测、缺血再灌注、滴定终点和超精确烧伤复苏：37。
DOI：
--
复制
发表时间：
2003
期刊：
影响因子：
--
通讯作者：
M. Jordan
中科院分区：
文献类型：
--
作者：
T. Light;J. Jeng;A. Jain;K. Jablonski;D. E. Kim;T. Phillips;A. Rizzo;M. Jordan
实时代谢监测不同的血管床提供了必要的原始数据进行超精确的烧伤休克复苏的基础上，逐秒评估区域组织灌注。它也说明了目前临床实践的缺点。在11例烧伤休克患者的临床复苏过程中，使用Paratrend监测仪连续监测动脉基础缺损。另外，在30% TBSA大鼠烧伤模型（N = 70）中，三个Paratrend监测器同时记录复苏期间0，2，4，6和8 ml/kg/ %TBSA的烧伤创面和结肠粘膜的动脉血气和组织pCO 2。结合先前报道的实际烧伤创面毛细血管灌注的激光多普勒图像分析了Paratrend数据。在目前的临床治疗中，持续监测动脉基础缺损显示烧伤休克复苏期间反复出现消退/恶化/消退周期。在大鼠模型中，烧伤创面和内脏循环中的组织pCO 2根据液体复苏速率而不同（假手术组和0 ml/kg/%TBSA之间以及2 ml/kg/ %TBSA和4 ml/kg/ %TBSA之间P <0.01）。烧伤创面pCO 2值与激光多普勒测定的实际毛细血管灌注相关性良好（p = -.48，P <.01）.结果表明：1）缺血-再灌注-缺血循环是目前临床治疗中的一个无意义的、重复的循环，在动脉基底缺损的恢复过程中出现了许多“错误的开始”; 2）在大鼠模型中，烧伤创面和内脏pCO 2的实时监测与补液速度呈剂量-反应关系;烧伤创面和内脏pCO 2与激光多普勒直接测量烧伤创面毛细血管灌注密切相关。任何一种技术都可以作为实时反馈控制的超精确复苏的复苏终点。
Real-time metabolic monitoring of varied vascular beds provides the raw data necessary to conduct ultraprecise burn shock resuscitation based on second-by-second assessment of regional tissue perfusion. It also illustrates shortcomings of current clinical practices. Arterial base deficit was continuously monitored during 11 clinical resuscitations of patients suffering burn shock using a Paratrend monitor. Separately, in a 30% TBSA rat burn model (N = 70), three Paratrend monitors simultaneously recorded arterial blood gas and tissue pCO 2 of the burn wound and colonic mucosa during resuscitation at 0, 2, 4, 6, and 8 ml/kg/ %TBSA. Paratrend data were analyzed in conjunction with previously reported laser Doppler images of actual burn wound capillary perfusion. With current clinical therapy, continuous monitoring of arterial base deficit revealed repetitive cycles of resolution/worsening/ resolution during burn shock resuscitation. In the rat model, tissue pCO 2 in both burn wounds and splanchnic circulation differed depending on the rate of fluid resuscitation (P <.01 between sham and 0 ml/kg/%TBSA and between 2 ml/kg/%TBSA and 4 ml/kg/ %TBSA). Burn wound pCO 2 values correlated well with laser Doppler determination of actual capillary perfusion (p = -.48, P <.01). The following conclusions were reached: 1) Gratuitous and repetitive ischemia-reperfusion-ischemia cycles plague current clinical therapy as demonstrated by numerous "false starts" in the resolution of arterial base deficit; 2) in a rat model, real-time monitoring of burn wound and splanchnic pCO 2 demonstrate a dose-response relationship with rate of fluid administration; and 3) burn wound and splanchnic pCO 2 are highly correlated with direct measurement of burn wound capillary perfusion by laser Doppler imager. Either technique can serve as a resuscitation endpoint for real-time feedback-controlled ultraprecise resuscitation.