Influence of haemodynamic stabilization with crystalloid and colloidal solutions on cerebral perfusion and integrity during haemorrhagic shock in a large animal model

晶体和胶体溶液稳定血流动力学对大型动物模型失血性休克期间脑灌注和完整性的影响

• 批准号: 390287704
• 负责人: Dr. Alexander Ziebart
• 金额: --
• 依托单位: Klinik für Anästhesiologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2017
• 资助国家: 德国
• 起止时间: 2016-12-31 至 2019-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/390287704?language=en
• 关键词: Influence; haemodynamic; stabilization; crystalloid; colloidal

A haemorrhagic shock through massive blood loss may occur in several acute or perioperative scenarios. Consequently, die organism is unable to provide effective blood and oxygen supply for its vital organs, which causes severe ischemia. Especially the brain rapidly suffers from ischemia due to limited tolerance, which causes irreversible damages. In the initial treatment several crystalloid or colloid solutions can be administered for fluid resuscitation to restore the microcirculation. This, however, does not necessarily warrant effective microcirculation and organ perfusion. The controversial discussion regarding the most effective solution for fluid resuscitation was recently intensified through the negative risk assessment for the longtime standard colloid hydroxyethyl starch (HES) by the European Medicines Agency. Despite the partial rehabilitation of HES through the German S3-Guideline Intravascular volume therapy in adults, a focus was set on alternative colloids and particularly the well-known gelatin-based solutions. However, for several indications there seems to be a lack of scientific data. Especially the influence of several fluids for treatment of haemorrhagic shock on the cerebral perfusion and integrity is widely unknown. The present research project examines these aspects in a prospective-randomized large animal study. Haemorrhagic shock is induced in anaesthetized pigs and consecutively treated by different solution for fluid resuscitation. Cerebral perfusion is monitored by means of 3-Tesla-MR imaging and arterial spin labeling technique over twelve hours following fluid resuscitation. During this period there will be no intervention in the first three hours. Afterwards heamodynamic and physiological stabilization will be aspired to baseline. To account for the complex disease pattern of haemorrhagic shock additional analyses focus on haemodynamics, coagulopathy, endothelial integrity, inflammatory response and blood gas parameters. Furthermore, the peripheral microcirculation and oxygenation is monitored in real-time. Post-mortem extended immunobiological and histopathological analyses are added. This study, which is closely oriented on clinical reality, assesses the best possible solution for fluid resuscitation regarding regeneration of the impaired organ perfusion.

在一些急性或围手术期的情况下，大量失血可能导致出血性休克。因此，死亡的生物体不能为其重要器官提供有效的血液和氧气供应，从而导致严重的缺血。特别是大脑由于耐受性有限而迅速缺血，造成不可逆的损伤。在初始治疗中，可以使用几种晶体或胶体溶液进行液体复苏，以恢复微循环。然而，这并不一定保证有效的微循环和器官灌注。最近，欧洲药品管理局对长期使用的标准胶体羟乙基淀粉（HES）进行了负面风险评估，从而加剧了关于液体复苏最有效解决方案的争议性讨论。尽管在成人中通过德国s3指南血管内容积治疗可以部分康复HES，但重点放在替代胶体上，特别是众所周知的基于明胶的溶液。然而，对于一些迹象，似乎缺乏科学数据。特别是几种治疗失血性休克的液体对脑灌注和脑完整性的影响尚不清楚。目前的研究项目在前瞻性随机大型动物研究中检验了这些方面。用不同的液体复苏液对麻醉猪进行失血性休克的连续治疗。液体复苏后12小时，采用3-特斯拉磁共振成像和动脉自旋标记技术监测脑灌注。在此期间，前三个小时内不得进行干预。之后，血流动力学和生理稳定将达到基线。为了解释出血性休克的复杂疾病模式，额外的分析侧重于血流动力学、凝血功能障碍、内皮完整性、炎症反应和血气参数。此外，还实时监测外周微循环和氧合。添加了死后扩展的免疫生物学和组织病理学分析。本研究紧密结合临床实际，探讨了损伤器官灌注再生液体复苏的最佳方案。

项目成果

Effect of fluid resuscitation on cerebral integrity: A prospective randomised porcine study of haemorrhagic shock.

液体复苏对脑完整性的影响：失血性休克的前瞻性随机猪研究

• DOI: 10.1097/eja.0000000000001416
• 发表时间: 2021
• 期刊: European Journal of Anaesthesiology
• 影响因子: 3.6
• 作者: Ziebart A;Möllmann C;Garcia-Bardon A;Kamuf J;Schäfer M;Thomas R;Hartmann E.K.
• 通讯作者: Hartmann E.K.

Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs.

猪脑血氧饱和度和扩展血流动力学监测引导的标准化失血性休克诱导

• DOI: 10.3791/59332
• 发表时间: 2019
• 期刊: Journal of visualized experiments : JoVE
• 作者: Ziebart A;Kamuf J;Ruemmler R;Rissel R;Gosling M;Garcia-Bardon A;Hartmann E.K.
• 通讯作者: Hartmann E.K.

Fluid resuscitation-related coagulation impairment in a porcine hemorrhagic shock model

猪失血性休克模型中液体复苏相关的凝血障碍

• DOI: 10.7717/peerj.8399
• 发表时间: 2020
• 期刊: PeerJ
• 影响因子: 2.7
• 作者: Ziebart A;Ruemmler R;Moellmann C;Kamuf J;Garcia-Bardon A;Thal S;Hartmann E.K.
• 通讯作者: Hartmann E.K.