Audonnet-Blaise Sandra, Krafft Marie-Pierre, Smani Younes, Mertes Paul-Michel, Marie Pierre-Yves, Labrude Pierre, Longrois Dan, Menu Patrick
Laboratoire d'Hématologie et de Physiologie, EA 3452, Faculté de Pharmacie, Université Henri Poincaré, 5 rue Albert Lebrun, B.P. 403, F-54001 Nancy Cedex, France.
Resuscitation. 2006 Jul;70(1):124-32. doi: 10.1016/j.resuscitation.2005.11.014. Epub 2006 Jun 8.
Studies have demonstrated that perfluorocarbon (PFC) emulsions associated with hyperoxia improved whole body oxygen delivery during resuscitation of acute haemorrhagic shock (HS). Nevertheless the microcirculatory effects of PFC and the potential deleterious effects of hyperoxic reperfusion are still of concern. We investigated (i) the ability of a newly formulated, small sized and highly stable PFC emulsion to increase skeletal muscle oxygen delivery and (ii) the effect of hyperoxic reperfusion on skeletal muscle metabolism after a brief period of ischaemia using an original, microdialysis-based method that allowed simultaneous measurement tissue oxygen pressure (PtiO2) and interstitial lactate and pyruvate. These measurements were carried out in anaesthetised and ventilated (FiO2 = 1) rabbits subjected to acute HS (50% of blood volume withdrawal) and either resuscitated with a PFC emulsion diluted with a 5% albumin solution (16.2 g PFC per kg body weight) (n = 10) or with a modified fluid gelatin solution (Gelofusine) (n = 10). We found no difference between the two groups for the haemodynamic and haematological variables (except for the venous oxygen partial pressure). However, a significant difference was observed in the slope of the regression linear relationship exhibited between the mean arterial pressure (MAP) and the PtiO2, PFC group showing a much steeper slope than Gelofusine group. In addition, PtiO2 values increased linearly with decreasing haematocrit (Hct) values in PFC-resuscitated animals and decreased linearly with decreasing Hct values in Gelofusine-resuscitated animals. There were no differences between the two groups concerning the blood and interstitial lactate/pyruvate ratios suggesting no deleterious effect of hyperoxic resuscitation in skeletal muscle. In conclusion these results suggest that resuscitation of severe, but brief, HS with PFC increased skeletal muscle oxygen delivery without measurable deleterious effects.
研究表明，与高氧相关的全氟碳（PFC）乳剂在急性失血性休克（HS）复苏期间可改善全身氧输送。然而，PFC对微循环的影响以及高氧再灌注的潜在有害影响仍令人担忧。我们研究了（i）一种新配制的、小尺寸且高度稳定的PFC乳剂增加骨骼肌氧输送的能力，以及（ii）使用一种基于微透析的原始方法，在短暂缺血后高氧再灌注对骨骼肌代谢的影响，该方法允许同时测量组织氧分压（PtiO2）以及间质乳酸和丙酮酸。这些测量是在麻醉并通气（FiO2 = 1）的兔子身上进行的，这些兔子经历急性HS（失血50%血容量），然后用5%白蛋白溶液稀释的PFC乳剂（每千克体重16.2克PFC）复苏（n = 10）或用改良的液体明胶溶液（佳乐施）复苏（n = 10）。我们发现两组在血流动力学和血液学变量方面没有差异（静脉血氧分压除外）。然而，在平均动脉压（MAP）和PtiO2之间呈现的回归线性关系斜率上观察到显著差异，PFC组的斜率比佳乐施组陡峭得多。此外，在PFC复苏的动物中，PtiO2值随血细胞比容（Hct）值降低而线性增加，而在佳乐施复苏的动物中，PtiO2值随Hct值降低而线性降低。两组在血液和间质乳酸/丙酮酸比值方面没有差异，这表明高氧复苏对骨骼肌没有有害影响。总之，这些结果表明，用PFC复苏严重但短暂的HS可增加骨骼肌氧输送，且无明显有害影响。
