INVESTIGATION OF NONINVASIVE MUSCLE PH AND OXYGEN SATURATION DURING UNCONTROLLED HEMORRHAGE AND RESUSCITATION IN SWINE
INVESTIGATION OF NONINVASIVE MUSCLE PH AND OXYGEN SATURATION DURING UNCONTROLLED HEMORRHAGE AND RESUSCITATION IN SWINE
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DOI：
10.1097/shk.0000000000000174
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发表时间：
2014-07-01
期刊：
影响因子：
3.1
通讯作者：
Sondeen, Jill L.
中科院分区：
文献类型：
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作者：
Soller, Babs;Smith, Charles;Sondeen, Jill L.
本研究评估了猪休克模型中无创测定的肌肉pH值（pHm）和肌肉氧饱和度（SmO2），该模型采用不受控制的出血和限制性容量复苏。麻醉的40公斤母猪持续出血，直到24 mL/kg的血液被取出（n = 26），随后脾脏被切开，在余下的实验中导致不受控制的出血。15分钟后，给予15 mL/kg复苏液（Hextend，新鲜冷冻血浆或血小板）30分钟。在基线、休克、复苏结束和研究结束（死亡或5小时）以及乳酸和碱过量时测量动脉和静脉血气。此外，还有7只动物接受了假手术。使用CareGuide 1100原型血氧仪从大腿后部连续收集光谱，并根据光谱计算pHm和SmO2。采用重复测量的双因素方差分析，随后采用Tukey事后比较来比较实验因素。结果表明，在复苏结束时和研究结束时，存活动物和非存活动物的静脉和肌肉pH值和SO2值相似。静脉和肌肉的pH和SO2因出血而显著下降，但乳酸和碱过量在此期间没有显着变化。无创pHm和SmO2实时跟踪复苏的充分性，显示在所有液体输送时，哪些动物会活下来，哪些会死亡。这项猪研究的结果表明，对创伤患者的进一步评估是有必要的。
This study evaluated noninvasively determined muscle pH (pHm) and muscle oxygen saturation (SmO2) in a swine shock model that used uncontrolled hemorrhage and restricted volume resuscitation. Anesthetized 40-kg female swine underwent hemorrhage until 24 mL/kg of blood was removed (n = 26), followed by transection of the spleen, causing uncontrolled hemorrhage throughout the remainder of the protocol. After 15 min, 15 mL/kg of resuscitation fluid (Hextend, fresh-frozen plasma or platelets) was given for 30 min. Arterial and venous blood gases were measured at baseline, shock, end of resuscitation, and end of the study (death or 5 h), along with lactate and base excess. In addition, seven animals underwent a sham procedure. Spectra were collected continuously from the posterior thigh using a prototype CareGuide 1100 Oximeter, and pHm and SmO2 were calculated from the spectra. A two-factor analysis of variance with repeated measures followed by Tukey post hoc comparisons was used to compare experimental factors. It was shown that, for both pH and SO2, venous and muscle values were similar to each other at the end of the resuscitation period and at the end of the study for both surviving and nonsurviving animals. pH and SO2, venous and muscle, significantly declined as a result of bleeding, but lactate and base excess did not show significant changes during this period. Noninvasive pHm and SmO2 tracked the adequacy of resuscitation in real time, indicating at the time all of the fluid was delivered, which animals would live and which would die. The results of this swine study indicate that further evaluation on trauma patients is warranted.