Stadlbauer Karl H, Wagner-Berger Horst G, Krismer Anette C, Voelckel Wolfgang G, Konigsrainer Alfred, Lindner Karl H, Wenzel Volker
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse, 6020 Innsbruck, Austria.
Crit Care. 2007;11(4):R81. doi: 10.1186/cc5977.
We sought to determine and compare the effects of vasopressin, fluid resuscitation and saline placebo on haemodynamic variables and short-term survival in an abdominal vascular injury model with uncontrolled haemorrhagic shock in pigs.
During general anaesthesia, a midline laparotomy was performed on 19 domestic pigs, followed by an incision (width about 5 cm and depth 0.5 cm) across the mesenterial shaft. When mean arterial blood pressure was below 20 mmHg, and heart rate had declined progressively, experimental therapy was initiated. At that point, animals were randomly assigned to receive vasopressin (0.4 U/kg; n = 7), fluid resuscitation (25 ml/kg lactated Ringer's and 25 ml/kg 3% gelatine solution; n = 7), or a single injection of saline placebo (n = 5). Vasopressin-treated animals were then given a continuous infusion of 0.08 U/kg per min vasopressin, whereas the remaining two groups received saline placebo at an equal rate of infusion. After 30 min of experimental therapy bleeding was controlled by surgical intervention, and further fluid resuscitation was performed. Thereafter, the animals were observed for an additional hour.
After 68 +/- 19 min (mean +/- standard deviation) of uncontrolled bleeding, experimental therapy was initiated; at that time total blood loss and mean arterial blood pressure were similar between groups (not significant). Mean arterial blood pressure increased in both vasopressin-treated and fluid-resuscitated animals from about 15 mmHg to about 55 mmHg within 5 min, but afterward it decreased more rapidly in the fluid resuscitation group; mean arterial blood pressure in the placebo group never increased. Seven out of seven vasopressin-treated animals survived, whereas six out of seven fluid-resuscitated and five out of five placebo pigs died before surgical intervention was initiated (P < 0.0001).
Vasopressin, but not fluid resuscitation or saline placebo, ensured short-term survival in this vascular injury model with uncontrolled haemorrhagic shock in sedated pigs.
我们试图确定并比较血管加压素、液体复苏和生理盐水安慰剂对猪腹部血管损伤伴失血性休克模型血流动力学变量及短期生存的影响。
在全身麻醉期间，对19头家猪进行中线剖腹术，随后在肠系膜轴上做一个切口（宽约5厘米，深0.5厘米）。当平均动脉血压低于20毫米汞柱且心率逐渐下降时，开始实验性治疗。此时，将动物随机分为三组，分别接受血管加压素（0.4单位/千克；n = 7）、液体复苏（25毫升/千克乳酸林格氏液和25毫升/千克3%明胶溶液；n = 7）或单次注射生理盐水安慰剂（n = 5）。接受血管加压素治疗的动物随后以每分钟0.08单位/千克的速度持续输注血管加压素，而其余两组以相同的输注速度接受生理盐水安慰剂。实验性治疗30分钟后，通过手术干预控制出血，并进行进一步的液体复苏。此后，对动物再观察1小时。
在68±19分钟（平均值±标准差）的失血性休克未控制期后开始实验性治疗；此时，各组之间的总失血量和平均动脉血压相似（无显著性差异）。血管加压素治疗组和液体复苏组的平均动脉血压在5分钟内从约15毫米汞柱升至约55毫米汞柱，但此后液体复苏组下降更快；安慰剂组的平均动脉血压从未升高。7只接受血管加压素治疗的动物中有7只存活，而7只接受液体复苏的动物中有6只以及5只接受安慰剂的猪在开始手术干预前死亡（P < 0.0001）。
在该镇静猪失血性休克未控制的血管损伤模型中，血管加压素可确保短期生存，而液体复苏和生理盐水安慰剂则不能。
