An experimental study on hypotensive resuscitation of near-lethal uncontrolled hemorrhage : Effects on tissue dysoxia, mortality and end-organ function at 72 hours

本研究的目的是评估组织缺氧、存活率和终末器官损伤的发生率，在正常血压和低血压复苏后3天。15只Beagle犬，体重13~16 kg，随机分为3组：A、B、C三组：A组(n=5)复苏至平均压100 mm，持续45min，B组(n=5)中度复苏至平均压力60 mm，持续45min，C组(n=5)中度复苏至平均压力60 mm，同时伴有高氧(PaO2=600 mm)45min。45min后，修复主动脉切开，复苏动物基础生理参数。在中度复苏的45min内，GR.C组的胃粘膜PCO_2和动脉血pH较GR.A和GR.B组显著改善。到72小时时，存活动物的生理参数已恢复到基线水平。A组至C组的72小时死亡率分别为80%、0%和0%，肾、肝和肺功能的测量与基线相比没有变化。没有终末器官损伤的组织学证据。在此模型中，45min的欠复苏没有导致终末器官损伤。有一种更大的存活率的趋势，高氧和中等程度的欠复苏(平均压力为60毫米汞柱)可以显著防止组织缺氧。

The purpose of this study was to evaluate tissue dysoxia, survival and incidence of end-organ injury, 3 days following normotensive and hypotensive resuscitation of uncontrolled hemorrhage. Fifteen canines (Beagle, BW 13〜16kg) were assigned to 3 groups : Groups A, B, and C were hemorrhaged to a mean pressure 40 mmHg in the presence of a 4-mm aortic tear : Group A (n=5) was resuscitated to a mean pressure 100 mmHg for 45 min ; Group B (n=5) was moderately under resuscitated to a mean pressure 60 mmHg for 45 min ; Group C (n=5) was moderately under resuscitated to a mean pressure 60 mmHg simultaneously with hyperoxia (PaO2=600 mmHg) for 45 min. After 45 min, the aortotomy was repaired, and animals were resuscitated baseline physiologic parameters. Gastric mucosal Pco_2, and arterial blood pH were significantly improved in Gr.C as compared to Gr.A and B during the 45 min of moderate under-resuscitation. By 72 h, physiologic parameters in surviving animals had returned to baseline levels. Seventy-two-hour mortality was 80%, 0%, and 0% for Group A through C. Measures of kidney, liver, and pulmonary function did not change from baseline. There was no histologic evidence of end-organ injury. In this model, 45 min of under-resuscitation did not result in end-organ injury. There was a trend toword greater survival, and tissue dysoxia was significantly prevented with hyperoxia with moderate under-resuscitation (mean pressure of 60 mmHg).