Meybohm Patrick, Cavus Erol, Bein Berthold, Steinfath Markus, Weber Bernd, Hamann Claudius, Scholz Jens, Dörges Volker
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
J Trauma. 2007 Mar;62(3):640-6. doi: 10.1097/01.ta.0000240962.62319.c8.
The present study was designed to evaluate the effects of hypertonic-hyperoncotic hydroxyethyl starch solution (HHS) combined with either norepinephrine (NE) or arginine vasopressin (AVP) on cerebral perfusion pressure (CPP) and brain metabolism after hemorrhagic shock.
Fourteen pigs were subjected to uncontrolled liver bleeding until hemodynamic decompensation followed by resuscitation using HHS (4 mL/kg) combined with either NE (bolus of 1000 microg; 60 microg/kg/hr; n = 7) or AVP (bolus of 10 U; 2 U/kg/hr; n = 7), respectively. Extracellular cerebral concentrations of glucose, glycerol, lactate, and the lactate/pyruvate ratio were assessed by microdialysis. After 30 minutes of therapy, bleeding was controlled by manual compression and all surviving animals were observed for 1 hour.
After hemodynamic decompensation, AVP resulted in a significantly higher increase of CPP (mean +/- SD; 47 +/- 19 versus 28 +/- 9 mm Hg; p < 0.01) and cerebral venous partial pressure of oxygen (66 +/- 8 versus 49 +/- 9 mm Hg; p < 0.05) compared with NE after 10 minutes of therapy. Hemodynamic data and blood gas variables were not different between groups during the remaining study period. Brain metabolism was found comparable in both groups at any time.
AVP was comparable to NE with respect to hemodynamics and blood gases, as well as brain metabolism in surviving animals throughout the study period. Our findings emphasize the importance of early resuscitation, as neuronal cell damage potentially starts immediately after onset of severe hemorrhage.
本研究旨在评估高渗高胶性羟乙基淀粉溶液（HHS）联合去甲肾上腺素（NE）或精氨酸加压素（AVP）对失血性休克后脑灌注压（CPP）和脑代谢的影响。
14只猪接受非控制性肝出血，直至血流动力学失代偿，随后分别使用HHS（4 mL/kg）联合NE（推注1000微克；60微克/千克/小时；n = 7）或AVP（推注10单位；2单位/千克/小时；n = 7）进行复苏。通过微透析评估细胞外脑葡萄糖、甘油、乳酸浓度以及乳酸/丙酮酸比值。治疗30分钟后，通过手动压迫控制出血，所有存活动物观察1小时。
血流动力学失代偿后，治疗10分钟时，与NE相比，AVP使CPP显著升高（均值±标准差；47±19对28±9毫米汞柱；p < 0.01），脑静脉血氧分压升高（66±8对49±9毫米汞柱；p < 0.05）。在其余研究期间，两组间血流动力学数据和血气变量无差异。在任何时间点，两组脑代谢均相当。
在整个研究期间，AVP在血流动力学、血气以及存活动物脑代谢方面与NE相当。我们的研究结果强调了早期复苏的重要性，因为严重出血发作后神经元细胞损伤可能立即开始。
