Direct Peritoneal Resuscitation Improves Obesity-Induced Hepatic Dysfunction after Trauma
Direct Peritoneal Resuscitation Improves Obesity-Induced Hepatic Dysfunction after Trauma
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DOI：
10.1016/j.jamcollsurg.2011.12.016
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发表时间：
2012-04-01
影响因子：
5.2
通讯作者：
Garrison, Richard N.
中科院分区：
文献类型：
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作者：
Matheson, Paul J.;Franklin, Glen A.;Garrison, Richard N.
背景：代谢综合征和相关的脂肪肝被认为是创伤患者预后不良的原因。实验表明，肥胖会影响肝脏血流。我们试图将肥胖、损伤严重程度和肝功能障碍与创伤结局的影响联系起来。我们假设，肥胖相关的肝功能障碍，可以减轻与新技术的连续性直接腹膜复苏（DPR）。研究设计：本研究的临床和实验武器。该临床研究是对ICU创伤患者（n = 72例肥胖，n = 187例非肥胖）的病例对照回顾性分析。实验研究采用肥胖大鼠失血性休克模型，评价DPR对肝脏血流量、肝功能和炎症介质的影响。在创伤患者中，单变量和多变量分析显示死亡率增加（p < 0.05）、脓毒症并发症（p < 0.05）、肝功能损害（p < 0.001）和肾损害（p < 0.05）随着体重指数和损伤严重程度评分的增加而增加。大鼠肥胖会损害肝血流量、肝功能、肾功能和炎症（白细胞介素[IL]-1 β、IL-6、高迁移率族蛋白B1[HMGB-1]）。此外，DPR休克复苏恢复肝血流量，改善器官功能，并扭转全身促炎反应。结论：我们的临床审查证实，肥胖症的创伤后果，无论损伤的严重程度。肥胖相关的肝和肾功能不全会因损伤严重程度而加重。在失血性休克复苏的肥胖大鼠模型中，添加DPR可以消除创伤诱导的肝脏、肾脏和炎症反应。我们的结论是，在临床复苏方案中加入DPR将有利于肥胖创伤患者。（美国科尔外科杂志2012;214：517-530。(C)2012年美国外科医生学会）
BACKGROUND: The metabolic syndrome and associated fatty liver disease are thought to contribute to poor outcomes in trauma patients. Experimentally, obesity compromises liver blood flow. We sought to correlate the effect of obesity, injury severity, and liver dysfunction with trauma outcomes. We hypothesized that obesity-related liver dysfunction could be mitigated with the novel technique of adjunctive direct peritoneal resuscitation (DPR).STUDY DESIGN: This study has clinical and experimental arms. The clinical study was a case-controlled retrospective analysis of ICU trauma patients (n = 72 obese, n = 187 nonobese). The experimental study was a hemorrhagic shock model in obese rats to assess the effect of DPR on liver blood flow, liver function, and inflammatory mediators.RESULTS: In trauma patients, univariate and multivariate analyses demonstrated increasing mortality (p < 0.05), septic complications (p < 0.05), liver dysfunction (p < 0.001), and renal impairment (p < 0.05) with increasing body mass index and injury severity score. Obesity in rats impairs liver blood flow, liver function, renal function, and inflammation (interleukin [IL]-1 beta, IL-6, high mobility group protein B1[HMGB-1]). The addition of DPR to shock resuscitation restores liver blood flow, improves organ function, and reverses the systemic proinflammatory response.CONCLUSIONS: Our clinical review substantiates that obesity worsens trauma outcomes regardless of injury severity. Obesity-related liver and renal dysfunction is aggravated by injury severity. In an obese rat model of resuscitated hemorrhagic shock, the addition of DPR abrogates trauma-induced liver, renal, and inflammatory responses. We conclude that the addition of DPR to the clinical resuscitation regimen will benefit the obese trauma patient. (J Am Coll Surg 2012;214:517-530. (C) 2012 by the American College of Surgeons)