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，生存和终末器官损伤的发生率，在正常和低血压复苏后3天不受控制的出血。15只犬（Beagle犬，体重13 ~ 16kg）被分为3组：A、B、C组在主动脉撕裂4 mm的情况下出血至平均压力40 mmHg； A组（n=5）复苏至平均压力100 mmHg 45 min；B组（n=5）中度复苏至平均血压60 mmHg，持续45分钟；C组（n=5）中度复苏至平均血压60 mmHg，同时高氧（PaO2=600 mmHg） 45分钟。45分钟后，修复主动脉切开术，对动物进行基线生理参数复苏。中度下复苏45 min时，胃黏膜Pco_2、动脉血pH均明显高于对照组。72小时后，存活动物的生理参数恢复到基线水平。A至c组72小时死亡率分别为80%、0%和0%。肾脏、肝脏和肺功能的测量值与基线相比没有变化。没有终末器官损伤的组织学证据。在这个模型中，45分钟的欠复苏没有导致终末器官损伤。有更高存活率的趋势，适度复苏下的高氧可显著预防组织缺氧（平均压力为60 mmHg）。

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).