Effect of gelatin-polysuccinat on cerebral oxygenation and microcirculation in a porcine haemorrhagic shock model.
Effect of gelatin-polysuccinat on cerebral oxygenation and microcirculation in a porcine haemorrhagic shock model.
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DOI：
10.1186/s13049-018-0477-2
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发表时间：
2018-02-09
期刊：
影响因子：
--
通讯作者：
Hartmann EK
中科院分区：
文献类型：
--
作者：
Ziebart A;Möllmann C;Garcia-Bardon A;Kamuf J;Schäfer M;Thomas R;Hartmann EK
在出血性休克的早期治疗中，必须通过液体复苏维持脑和终末器官的氧供应。明胶-聚琥珀酸酯（GP）最近重新受到关注，尽管其风险特征仍不清楚，对大脑和外周微循环的影响也未知。本研究探讨了GP与平衡电解质溶液（BEL）对猪失血性休克模型脑局部氧饱和度和外周微循环的影响。在动物护理委员会批准后，在27只麻醉猪中通过动脉抽血诱导出血性休克。因此，动物通过GP或BEL接受快速液体复苏以补充移除的血液量，或保持不治疗（n = 3 × 9）。两个多小时的脑局部氧饱和度的近红外光谱和周围颊微循环的白光光谱和激光多普勒血流仪相结合的记录。次要参数包括扩展的血液动力学、肺功能测定、血液学和血气参数。这两种液体复苏制度充分稳定的宏观和微循环在出血性休克与GP输注后更显着的效果。GP给药通过大量血液稀释导致脑局部氧饱和度持续严重受损。两个液体复苏组的存活率均为100%，但未经治疗的对照组仅为33%。等量的GP和BEL足以稳定体循环和微循环灌注。GP强制液体复苏应谨慎应用，以防止血液稀释引起的脑氧输送障碍。
During early treatment of haemorrhagic shock maintenance of cerebral and end-organ oxygen supply by fluid resuscitation is mandatory. Gelatin-polysuccinat (GP) recently regained attention despite a still unclear risk profile and widely unknown effects on cerebral and peripheral microcirculation. This study investigates the effects of GP versus balanced electrolyte solution (BEL) with focus on cerebral regional oxygen saturation and peripheral microcirculation in a porcine haemorrhagic shock model. After Animal Care Committee approval haemorrhagic shock was induced by arterial blood withdrawal in 27 anaesthetized pigs. Consequently, the animals received rapid fluid resuscitation by either GP or BEL to replace the removed amount of blood, or remained untreated (n = 3 × 9). Over two hours cerebral regional oxygen saturation by near-infrared spectroscopy and peripheral buccal microcirculation by combined white-light spectrometry and laser-Doppler flowmetry were recorded. Secondary parameters included extended haemodynamics, spirometry, haematological and blood gas parameters. Both fluid resuscitation regimes sufficiently stabilized the macro- and microcirculation in haemorrhagic shock with a more pronounced effect following GP infusion. GP administration led to a persisting, critical impairment of cerebral regional oxygen saturation through considerable haemodilution. Survival rates were 100% in both fluid resuscitation groups, but only 33% in the untreated control. Equal amounts of GP and BEL sufficiently stabilize systemic circulation and microcirculatory perfusion. Forced fluid resuscitation by GP should be applied with caution to prevent haemodilution-induced impairment of cerebral oxygen delivery.
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