Norepinephrine Decreases Fluid Requirements and Blood Loss While Preserving Intestinal Villi Microcirculation during Fluid Resuscitation of Uncontrolled Hemorrhagic Shock in Mice
Norepinephrine Decreases Fluid Requirements and Blood Loss While Preserving Intestinal Villi Microcirculation during Fluid Resuscitation of Uncontrolled Hemorrhagic Shock in Mice
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DOI：
10.1097/aln.0000000000000639
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发表时间：
2015-05-01
期刊：
影响因子：
8.8
通讯作者：
Duranteau, Jacques
中科院分区：
文献类型：
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作者：
Harrois, Anatole;Baudry, Nathalie;Duranteau, Jacques
背景资料：在失血性休克复苏过程中，使用去甲肾上腺素稳定平均动脉压（MAP）是有争议的，因为它可能对局部循环产生有害影响。作者研究了去甲肾上腺素对失血性休克液体复苏时肠道微循环的影响。小鼠（每组n = 6）通过尾部切割提交不受控制的失血性休克，随机分配至液体复苏，但不含去甲肾上腺素，目标MAP水平为50 mmHg（FR 50）或60 mmHg（FR 60）或使用液体和去甲肾上腺素进行复苏，以使MAP水平达到50 mmHg（FRNE 50）或60 mmHg（FRNE 60）。结果：复苏液加去甲肾上腺素组的液体需要量低于复苏液不加去甲肾上腺素组（FR 50中74.6 +/- 45.1 vs. FRNE 50中28.1 +/- 10.0 mu l/g; P = 0.004; FR 60中161.9 +/- 90.4 vs. FRNE 60中44.5 +/- 24.0 mu l/g; P = 0.041）。FR 50和FRNE 50之间的失血量无统计学差异（14.8 +/- 8.3 vs. 8.5 +/- 2.9 mu l/g; P = 0.180），但FRNE 60的失血量显著低于FR 60（10.1 +/- 4.2 vs. 22.6 +/- 9.6 mu l/g; P = 0.015）。在无去甲肾上腺素液体复苏组（FR 50和FR 60）和有去甲肾上腺素液体复苏组（FRNE 50和FRNE 60）中，这种有益的作用与肠道微循环的恢复程度相同。
Background: Norepinephrine administration is controversial during hemorrhagic shock resuscitation to stabilize mean arterial pressure (MAP) level because it could have deleterious effects on local circulations. The authors investigated the effect of norepinephrine on intestinal microcirculation during fluid resuscitation in uncontrolled hemorrhagic shock.Methods: Mice (n = 6 per group) submitted to an uncontrolled hemorrhagic shock by tail section were randomly assigned to a resuscitation with fluid but without norepinephrine to target a MAP level of 50 mmHg (FR50) or 60 mmHg (FR60) or a resuscitation with fluid and norepinephrine to target a MAP level of 50 mmHg (FRNE50) or 60 mmHg (FRNE60). Intestinal microcirculation was observed by intravital microscopy.Results: Fluid requirements were lower in groups resuscitated with fluid and norepinephrine than in groups resuscitated with fluid without norepinephrine (74.6 +/- 45.1 in FR50 vs. 28.1 +/- 10.0 mu l/g in FRNE50; P = 0.004 and 161.9 +/- 90.4 in FR60 vs. 44.5 +/- 24.0 mu l/g in FRNE60; P = 0.041). Blood loss was not statistically different between FR50 and FRNE50 (14.8 +/- 8.3 vs. 8.5 +/- 2.9 mu l/g; P = 0.180) but was significantly lower in FRNE60 than in FR60 (10.1 +/- 4.2 vs. 22.6 +/- 9.6 mu l/g; P = 0.015). This beneficial effect was associated with the restoration of intestinal microcirculation to the same extent in fluid resuscitated groups without norepinephrine (FR50 and FR60) and fluid resuscitated groups with norepinephrine (FRNE50 and FRNE60).Conclusions: During MAP-directed resuscitation of uncontrolled hemorrhagic shock, the administration of norepinephrine decreased blood loss and fluid requirements while preserving intestinal villi microcirculation.